{"hospital_name": "Baptist Women's Health Center LLC dba Saint Thomas Hospital for Specialty Surgery", "last_updated_on": "2026-04-14", "version": "3.0.0", "pid": "1549997394", "rid": "12683", "location_name": ["St. Thomas Hospital for Specialty Surgery"], "hospital_address": ["2011 Murphy Ave #400, Nashville, TN 37203"], "type_2_npi": ["1336119627"], "license_information": {"license_number": "0000000152", "state": "TN"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "1", "code_information": [{"code": "10060201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "setting": "both", "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 32.53, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "10", "code_information": [{"code": "1006031", "type": "CDM"}], "standard_charges": [{"gross_charge": 6469.0, "setting": "both", "billing_class": "facility"}]}, {"description": "12 Lead EKG 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1554967", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 9.01, "maximum": 584.01, "gross_charge": 124.0, "discounted_cash": 73.76, "estimated_discounted_cash": 124.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "12 Lead EKG w/o interp 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1558406", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 9.01, "maximum": 584.01, "gross_charge": 124.0, "discounted_cash": 73.76, "estimated_discounted_cash": 124.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1LYR 16FR10ML 100%SIL TMP TRAY", "code_information": [{"code": "DYND160816T", "type": "CDM"}], "standard_charges": [{"gross_charge": 195.09, "setting": "both", "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 215.22, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 160.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 101.37, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 264.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 264.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 192.49, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 192.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 111.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 215.88, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 83.07, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 83.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2", "code_information": [{"code": "1006022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 842.0, "setting": "both", "billing_class": "facility"}]}, {"description": "2019 CORONAVIRUS SARS-CoV-2  U0003", "code_information": [{"code": "U0003", "type": "HCPCS"}, {"code": "45687007", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.33, "maximum": 32.33, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 912.74, "maximum": 985.76, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 912.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 912.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 985.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 912.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3", "code_information": [{"code": "1006023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 957.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 317.17, "maximum": 584.01, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 317.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 317.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 343.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 317.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 317.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 343.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 74.55, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 74.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 20.84, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}], "standard_charges": [{"minimum": 53.23, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4", "code_information": [{"code": "1006024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1404.0, "setting": "both", "billing_class": "facility"}]}, {"description": "4MM X 120MM SCHANZ SCREW", "code_information": [{"code": "KIT0284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.16, "setting": "both", "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5", "code_information": [{"code": "1006025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1966.0, "setting": "both", "billing_class": "facility"}]}, {"description": "500ML PRESSURE INFUSER W STOPCOCK", "code_information": [{"code": "DYNJAAPI500S", "type": "CDM"}], "standard_charges": [{"gross_charge": 37.54, "setting": "both", "billing_class": "facility"}]}, {"description": "500ML PRESSURE INFUSER W THUMBWHEEL", "code_information": [{"code": "DYNJAAPI500T", "type": "CDM"}], "standard_charges": [{"gross_charge": 54.86, "setting": "both", "billing_class": "facility"}]}, {"description": "6", "code_information": [{"code": "1006027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2813.0, "setting": "both", "billing_class": "facility"}]}, {"description": "7", "code_information": [{"code": "1006028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "8", "code_information": [{"code": "1006029", "type": "CDM"}], "standard_charges": [{"gross_charge": 3936.0, "setting": "both", "billing_class": "facility"}]}, {"description": "85014 Hematocrit Price", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "34208647", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.13, "maximum": 584.01, "gross_charge": 10.0, "discounted_cash": 3.08, "estimated_discounted_cash": 11.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "9", "code_information": [{"code": "1006030", "type": "CDM"}], "standard_charges": [{"gross_charge": 5626.0, "setting": "both", "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "A&A LINE CELL SAVER", "code_information": [{"code": "208-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD BINDER 2X", "code_information": [{"code": "79-890496", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 45.76, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PAD 5INX9IN STERILE LATEX-FREE", "code_information": [{"code": "C-ABP59S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 323.51, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 323.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}], "standard_charges": [{"minimum": 377.8, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 270.0, "maximum": 584.01, "discounted_cash": 390.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 481.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1695.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1696.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1076.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2397.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2035.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 835.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2279.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4578.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6450.37, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6450.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1826.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2005.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2013.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 368.83, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"minimum": 289.21, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 289.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5982.34, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5982.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3853.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1188.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 247.35, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 247.35, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "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": 2.69, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 166.35, "estimated_discounted_cash": 11.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 316.66, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 547.95, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 457.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 457.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 499.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 499.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 683.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 497.14, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 497.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 578.18, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 578.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 671.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 274.41, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 274.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 4802.19, "maximum": 10098.0, "discounted_cash": 8965.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6664.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6664.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10098.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8847.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5829.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4976.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4802.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2785.78, "maximum": 5653.29, "discounted_cash": 7522.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3731.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3731.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5653.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4953.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3263.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2785.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4172.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 310.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 42.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 75.99, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSORABLE HEMOSTATIC SURGICEL ORIGINAL  4INX8 IN 1952S", "code_information": [{"code": "1952S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.44, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN  SPONGE (SURGIFOAM) SIZE 12-7", "code_information": [{"code": "MED0001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.69, "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": 247.55, "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": 247.55, "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": 157.68, "setting": "both", "billing_class": "facility"}]}, {"description": "ACAPatch, per square centimeter", "code_information": [{"code": "Q4325", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 349.09, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 349.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESSORY HOLSTER FOR BOVIE PENCIL", "code_information": [{"code": "E2400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.43, "setting": "both", "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"minimum": 297.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 400.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 400.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 432.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 400.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 297.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACESSO DL, PER SQ CM", "code_information": [{"code": "Q4293", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACESSO TL, PER SQ CM", "code_information": [{"code": "Q4300", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 500 MG INJ (DIAMOX)", "code_information": [{"code": "MED0005", "type": "CDM"}], "standard_charges": [{"gross_charge": 62.48, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETIC ACID 0.25% TOP SOL 1000 ML", "code_information": [{"code": "MED0006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETONE ASSAY", "code_information": [{"code": "82010", "type": "CPT"}], "standard_charges": [{"minimum": 7.35, "maximum": 584.01, "discounted_cash": 10.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 11.06, "maximum": 584.01, "discounted_cash": 15.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 584.01, "discounted_cash": 23.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 584.01, "discounted_cash": 23.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 150.24, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 161.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 161.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 174.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 161.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"minimum": 43.39, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 21.23, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 29.36, "maximum": 584.01, "discounted_cash": 42.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 29.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 29.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 78.26, "maximum": 584.01, "discounted_cash": 113.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 160.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 70.43, "maximum": 584.01, "discounted_cash": 101.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 155.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 144.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 70.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 70.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 121.1, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 207.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVATE MATRIX, PER SQ CM", "code_information": [{"code": "Q4301", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVATOR PATIENT REACTIV8 7000", "code_information": [{"code": "7000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 65.01, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 74.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 65.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 38.69, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 74.44, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 80.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 39.18, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 59.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 59.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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10204.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8726.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2505.53, "maximum": 8382.89, "discounted_cash": 5354.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5532.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5532.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8382.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7344.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4839.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4130.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2505.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"minimum": 215.48, "maximum": 215.48, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 312.14, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 363.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 14.84, "maximum": 584.01, "discounted_cash": 21.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 10.8, "maximum": 584.01, "discounted_cash": 21.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER CABLE TEMP PROBE 7 PIN CONNECTOR 1/4IN X 1 1/2M", "code_information": [{"code": "5198333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CAP LUER-LOK MALE STERILE SINGLE", "code_information": [{"code": "408530", "type": "CDM"}], "standard_charges": [{"gross_charge": 7.61, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CONNECTORS", "code_information": [{"code": "395282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.79, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CUFF CLR UNIVERSAL RESPIRATORY", "code_information": [{"code": "1421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER HND SWITCHING COMPATIBLE W/ HBC05 HC325 HDH05 HK105 HP054 DISP", "code_information": [{"code": "HSA08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.27, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER LUER LOCK BLUE BLOOD TRANSFER MALE", "code_information": [{"code": "364902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.43, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER MDI 15MM X 15MM", "code_information": [{"code": "RTC15-D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.19, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 59.35, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 12.99, "maximum": 584.01, "discounted_cash": 18.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 11.58, "maximum": 584.01, "discounted_cash": 16.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 19.58, "maximum": 584.01, "discounted_cash": 28.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1092.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIVE  MINI TOPICAL DERMABOND .36ML DHVM12", "code_information": [{"code": "DHVM12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.54, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE MASTISOL 2/3CC VIAL FRN052348Z", "code_information": [{"code": "FRN052348Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE MED SURG SPARE MED A PRECISION BOSTON SCIENTIFIC", "code_information": [{"code": "SC-4320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE SKIN 0.7 ML TOPICAL HIGH VISCOSITY 2-OCTYL CYANOACRYLATE DERMABOND", "code_information": [{"code": "DHV12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.74, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE SKIN DERMABOND ADVANCED 0.7 DNX6", "code_information": [{"code": "DNX6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.01, "setting": "both", "billing_class": "facility"}]}, {"description": "ADHESIVE TISSUE 0.7 GRAM TUBE SURG OCTYSEAL", "code_information": [{"code": "M1201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.46, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRANSFER TRUNK 10 SQ CM OR LESS 14000", "code_information": [{"code": "14000", "type": "CPT"}, {"code": "1479879", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2579.72, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE DRILL SIZE 2.3MM 7601-90009", "code_information": [{"code": "7601-90009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUSTMENT EXTERNAL FIXATOR 20693", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "1479881", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 570.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.88, "maximum": 26.88, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 47.33, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.02, "maximum": 49.7, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "G0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.02, "maximum": 49.7, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 40.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 50.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10171.18, "maximum": 30252.72, "discounted_cash": 19597.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19967.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19967.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30252.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26505.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17463.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14907.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10171.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6395.48, "maximum": 22715.0, "discounted_cash": 12511.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14992.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14992.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22715.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19901.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13112.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11193.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6395.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 462.39, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 482.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 482.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 521.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 482.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 482.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 462.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENALINE EPINEPHRINE HCL TOPICAL SOLUTION 1MG/ML 30ML", "code_information": [{"code": "MED0008", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 777.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1174.83, "discounted_cash": 1696.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN 30 MIN", "code_information": [{"code": "99497", "type": "CPT"}], "standard_charges": [{"minimum": 118.79, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 118.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"minimum": 106.97, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 53.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", 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"standard_charge_dollar": 222.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"minimum": 44.72, "maximum": 584.01, "discounted_cash": 273.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL MASK ADULT  22MM CONN 1083", "code_information": [{"code": "1083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.54, "setting": "both", "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFFINITY1 SQUARE CM", "code_information": [{"code": "Q4159", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}], "standard_charges": [{"minimum": 449.67, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7537.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4966.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4239.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4815.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2615.76, "maximum": 7479.9, "discounted_cash": 5612.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4936.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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28883.1, "discounted_cash": 10068.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19063.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19063.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28883.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25305.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16673.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14232.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5082.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8284.67, "maximum": 32336.74, "discounted_cash": 16674.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21342.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21342.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32336.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28331.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18666.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15934.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8284.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3648.95, "maximum": 22812.73, "discounted_cash": 7187.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15056.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15056.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22812.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19987.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13168.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11241.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3648.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}], "standard_charges": [{"minimum": 6.28, "maximum": 584.01, "discounted_cash": 9.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 756.59, "maximum": 756.59, "discounted_cash": 1092.85, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 1109.6, "discounted_cash": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1026.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1026.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1109.6, "methodology": "fee 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[{"minimum": 201.71, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, 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{"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.88, "maximum": 45.23, "discounted_cash": 13.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 41.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN HUMAN 5% IV SOL 250 ML", "code_information": [{"code": "MED0762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 102.09, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 30.55, "maximum": 584.01, "discounted_cash": 44.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, 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CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1555.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM", "code_information": [{"code": "Q4116", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT CANCELLOUS 1-4MM 30CC LYO", "code_information": [{"code": "500721", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CORTICAL DOWEL 12X6MM LYO", "code_information": [{"code": "1807101", "type": "CDM"}], "standard_charges": [{"gross_charge": 1100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CORTICAL DOWEL 12X7MM LYO", "code_information": [{"code": "1807221", "type": "CDM"}], "standard_charges": [{"gross_charge": 1100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT CORTICAL DOWEL12X8MM LYO", "code_information": [{"code": "1807301", "type": "CDM"}], "standard_charges": [{"gross_charge": 1100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4115", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4123", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN AC, 1 CM", "code_information": [{"code": "Q4141", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [{"code": "Q4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA 16 IPG CHARGE SYSTEM RC 2 LINEAR MN000SC1240C0", "code_information": [{"code": "MN000SC1240C0", "type": "CDM"}], "standard_charges": [{"gross_charge": 79588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}], "standard_charges": [{"minimum": 13.01, "maximum": 584.01, "discounted_cash": 18.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [{"code": "82103", "type": "CPT"}], "standard_charges": [{"minimum": 12.1, "maximum": 584.01, "discounted_cash": 17.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}], "standard_charges": [{"minimum": 15.3, "maximum": 584.01, "discounted_cash": 22.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}], "standard_charges": [{"minimum": 57.97, "maximum": 584.01, "discounted_cash": 83.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN SERUM", "code_information": [{"code": "82105", "type": "CPT"}], "standard_charges": [{"minimum": 15.09, "maximum": 584.01, "discounted_cash": 21.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"minimum": 70.41, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"minimum": 61.36, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX CN NPGT PRGRMG", "code_information": [{"code": "95977", "type": "CPT"}], "standard_charges": [{"minimum": 69.27, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS NPGT W/O PRGRMG", "code_information": [{"code": "95970", "type": "CPT"}], "standard_charges": [{"minimum": 26.82, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 126.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 126.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 136.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 126.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL CN NPGT PRGRMG", "code_information": [{"code": "95976", "type": "CPT"}], "standard_charges": [{"minimum": 51.94, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL SP/PN NPGT W/PRGRM", "code_information": [{"code": "95971", "type": "CPT"}], "standard_charges": [{"minimum": 68.28, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SOFTWARE", "code_information": [{"code": "93784", "type": "CPT"}], "standard_charges": [{"minimum": 63.69, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 99.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 99.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 107.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 99.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 63.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW A/R", "code_information": [{"code": "93788", "type": "CPT"}], "standard_charges": [{"minimum": 7.7, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"minimum": 25.09, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW REC ONLY", "code_information": [{"code": "93786", "type": "CPT"}], "standard_charges": [{"minimum": 30.9, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINES VAGINAL FLUID QUAL", "code_information": [{"code": "82120", "type": "CPT"}], "standard_charges": [{"minimum": 5.39, "maximum": 584.01, "discounted_cash": 7.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACID SINGLE QUAL", "code_information": [{"code": "82127", "type": "CPT"}], "standard_charges": [{"minimum": 12.76, "maximum": 584.01, "discounted_cash": 18.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS MULT QUAL", "code_information": [{"code": "82128", "type": "CPT"}], "standard_charges": [{"minimum": 12.48, "maximum": 584.01, "discounted_cash": 18.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUAN 6 OR MORE", "code_information": [{"code": "82139", "type": "CPT"}], "standard_charges": [{"minimum": 10.8, "maximum": 584.01, "discounted_cash": 21.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 10.8, "maximum": 584.01, "discounted_cash": 25.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 20.68, "maximum": 584.01, "discounted_cash": 29.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO+, PER SQ CM", "code_information": [{"code": "Q4299", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO, PER SQ CM", "code_information": [{"code": "Q4298", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO OR DERMA TL, PER SQ CM", "code_information": [{"code": "Q4225", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO QUAD-CORE, PER SQ CM", "code_information": [{"code": "Q4294", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO TRI-CORE, PER SQ CM", "code_information": [{"code": "Q4295", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO WOUND, PER SQUARE CM", "code_information": [{"code": "Q4181", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO-MAXX OR LITE PER SQ CM", "code_information": [{"code": "Q4239", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOAMP-MP PER SQ CM", "code_information": [{"code": "Q4250", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOARMOR 1 SQ CM", "code_information": [{"code": "Q4188", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, GUARDIAN 1 SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 155.39, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 205.46, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCORE PER SQ CM", "code_information": [{"code": "Q4227", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNION BIO OR AXOBIO SQ CM", "code_information": [{"code": "Q4211", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOREPAIR OR ALTIPLY SQ CM", "code_information": [{"code": "Q4235", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT PATCH, PER SQ CM", "code_information": [{"code": "Q4247", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 8.42, "maximum": 584.01, "discounted_cash": 12.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOWRAP2 PER SQ CM", "code_information": [{"code": "Q4221", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIPLY, PER SQ CM", "code_information": [{"code": "Q4249", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 919.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 822.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 944.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1172.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 846.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE METACARPAL BONE", "code_information": [{"code": "26910", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 977.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1132.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 771.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 851.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 898.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 753.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1030.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 628.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 789.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [{"code": "240", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12997.15, "maximum": 41271.6, "discounted_cash": 25487.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27239.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27239.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41271.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36159.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23824.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20337.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12997.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [{"code": "239", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22479.68, "maximum": 96266.9, "discounted_cash": 44006.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63536.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63536.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 96266.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84342.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 55571.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 47437.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22479.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [{"code": "241", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6738.68, "maximum": 34011.94, "discounted_cash": 12378.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22448.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22448.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34011.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29799.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19633.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16760.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6738.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9628.03, "maximum": 44094.8, "discounted_cash": 20347.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29102.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29102.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44094.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38633.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25454.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21728.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9628.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20015.22, "maximum": 72889.8, "discounted_cash": 38384.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 48107.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 48107.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72889.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63861.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42076.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 35918.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 20015.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "476", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5190.92, "maximum": 23123.82, "discounted_cash": 10552.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15261.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15261.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23123.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20259.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13348.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11394.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5190.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 921.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 881.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 696.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 885.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1398.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1105.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1936.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1511.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1078.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 995.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8620.73, "maximum": 30380.73, "discounted_cash": 16723.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20051.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20051.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30380.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26617.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17537.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14970.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8620.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17249.5, "maximum": 43289.55, "discounted_cash": 31182.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28571.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28571.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43289.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37927.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24989.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21331.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17249.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5556.88, "maximum": 24163.08, "discounted_cash": 12681.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15947.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15947.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24163.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21170.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13948.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11906.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5556.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 663.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 397.11, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 397.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 949.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 877.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 531.28, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 531.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 1 OR 2", "code_information": [{"code": "80327", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5618.47, "maximum": 15615.02, "discounted_cash": 11702.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10306.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10306.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15615.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13680.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9013.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7694.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5618.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10563.03, "maximum": 29280.91, "discounted_cash": 20525.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19325.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19325.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29280.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25654.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16902.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14428.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10563.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3931.46, "maximum": 11931.5, "discounted_cash": 7784.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7874.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7874.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11931.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10453.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6887.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5879.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3931.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "type": "CPT"}], "standard_charges": [{"minimum": 38.34, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}], "standard_charges": [{"minimum": 314.98, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 314.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 314.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 340.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 314.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 391.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 1 OR 2", "code_information": [{"code": "80329", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 44.52, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 45.86, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 49.92, "maximum": 584.01, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 62.45, "maximum": 4936.0, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 62.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2194.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR FISTULA NEEDLE 1/2 CIRCLE CUTTING EDGE", "code_information": [{"code": "1832-7D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.51, "setting": "both", "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 28.44, "maximum": 28.44, "discounted_cash": 41.08, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 25.95, "maximum": 584.01, "discounted_cash": 37.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANEROID HANDHELD BLACK PVC TUBING AND BLADDER NYLON RANGEFINDER LF ADLT REUSE", "code_information": [{"code": "MDS9380", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.71, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE REPLACEMENT", "code_information": [{"code": "1486", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE/FT ARTHROSCOPY", "code_information": [{"code": "1464", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ANORECTAL SURGERY", "code_information": [{"code": "902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ARTHROSCOPY OF HIP", "code_information": [{"code": "1202", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BICEPS TENDON REPAIR", "code_information": [{"code": "1716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF NOSE", "code_information": [{"code": "164", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF THYROID", "code_information": [{"code": "322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER STONE SURG", "code_information": [{"code": "870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER SURGERY", "code_information": [{"code": "910", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER TUMOR SURG", "code_information": [{"code": "912", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEEDING CONTROL", "code_information": [{"code": "916", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEPHAROPLASTY", "code_information": [{"code": "103", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BODY CAST PROCEDURE", "code_information": [{"code": "1130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BONE ASPIRATE/BX", "code_information": [{"code": "1112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN 4-9 PERCENT", "code_information": [{"code": "1952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN EACH 9 PERCENT", "code_information": [{"code": "1953", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN LESS 4 PERCENT", "code_information": [{"code": "1951", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/O PUMP", "code_information": [{"code": "566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIAC ELECTROPHYS", "code_information": [{"code": "537", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIOVERTER/DEFIB", "code_information": [{"code": "534", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CAT OR MRI SCAN", "code_information": [{"code": "1922", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CATHETERIZE HEART", "code_information": [{"code": "1920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST LINING BIOPSY", "code_information": [{"code": "522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST PROCEDURE", "code_information": [{"code": "520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST WALL REPAIR", "code_information": [{"code": "472", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CLEFT PALATE REPAIR", "code_information": [{"code": "172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH COLLAR BONE BIOPSY", "code_information": [{"code": "454", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CORNEAL TRANSPLANT", "code_information": [{"code": "144", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CORRECT HEART RHYTHM", "code_information": [{"code": "410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH CRANIAL SURG NOS", "code_information": [{"code": "210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ARTERIOGRAPHY", "code_information": [{"code": "1916", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ELBOW ARTHROSCOPY", "code_information": [{"code": "1732", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX KNEE ARTHROSCOPY", "code_information": [{"code": "1382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH DX WRIST ARTHROSCOPY", "code_information": [{"code": "1829", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR EXAM", "code_information": [{"code": "124", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR SURGERY", "code_information": [{"code": "120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW AREA SURGERY", "code_information": [{"code": "1710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW REPLACEMENT", "code_information": [{"code": "1760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ELECTROSHOCK", "code_information": [{"code": "104", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ESOPHAGEAL SURGERY", "code_information": [{"code": "500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH EYE EXAM", "code_information": [{"code": "148", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FACE/SKULL BONE SURG", "code_information": [{"code": "190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FAT LAYER REMOVAL", "code_information": [{"code": "802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FOR LIVER BIOPSY", "code_information": [{"code": "702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH FX REPAIR PELVIS", "code_information": [{"code": "1173", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH GENITALIA SURGERY", "code_information": [{"code": "920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD NERVE SURGERY", "code_information": [{"code": "222", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD VESSEL SURGERY", "code_information": [{"code": "216", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD/NECK/PTRUNK", "code_information": [{"code": "300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/ARREST", "code_information": [{"code": "563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR < 1 YR", "code_information": [{"code": "834", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR PREEMIE", "code_information": [{"code": "836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP ARTHROPLASTY", "code_information": [{"code": "1214", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT PROCEDURE", "code_information": [{"code": "1200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT SURGERY", "code_information": [{"code": "1210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERAL LESION SURG", "code_information": [{"code": "1758", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, 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"outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTEROSCOPE/GRAPH", "code_information": [{"code": "952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH INSERT PENIS DEVICE", "code_information": [{"code": "938", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH INTRCRN NERVE", "code_information": [{"code": "220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH IRIDECTOMY", "code_information": [{"code": "147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": 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"payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY/URETER SURG", "code_information": [{"code": "862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTHROPLASTY", "code_information": [{"code": "1402", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT CASTING", "code_information": [{"code": "1420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT PROCEDURE", "code_information": [{"code": "1380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT SURGERY", "code_information": [{"code": "1400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VEINS SURGERY", "code_information": [{"code": "1430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VESSEL SURG", "code_information": [{"code": "1432", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LARYNX/TRACH < 1 YR", "code_information": [{"code": "326", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LEG ARTERIES SURG", "code_information": [{"code": "1500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LENS SURGERY", "code_information": [{"code": "142", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM CASTING", "code_information": [{"code": "1860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM PROCEDURE", "code_information": [{"code": "1820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM VEIN SURG", "code_information": [{"code": "1850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG BONE SURG", "code_information": [{"code": "1480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG CASTING", "code_information": [{"code": "1490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG PROCEDURE", "code_information": [{"code": "1462", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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"standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LUMBAR PUNCTURE", "code_information": [{"code": "635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM ARTERY SURG", "code_information": [{"code": "1840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM EMBOLECTOMY", "code_information": [{"code": "1842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM VEIN REPAIR", "code_information": [{"code": "1852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH N BLOCK/INJ PRONE", "code_information": [{"code": "1992", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK ORGAN 1YR/>", "code_information": [{"code": "320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "352", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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[{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ONE LUNG VENTILATION", "code_information": [{"code": "541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PACEMAKER INSERTION", "code_information": [{"code": "530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS PROCEDURE", "code_information": [{"code": "1160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "174", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON FEMUR", "code_information": [{"code": "1220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON MOUTH", "code_information": [{"code": "170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURES ON EYE", "code_information": [{"code": "140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL LEG SURGERY", "code_information": [{"code": "1482", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "914", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF RIB", "code_information": [{"code": "470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "926", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "928", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF VULVA", "code_information": [{"code": "906", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CERVIX", "code_information": [{"code": "948", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CLEFT LIP", "code_information": [{"code": "102", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH REVISE HIP REPAIR", "code_information": [{"code": "1215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SALIVARY GLAND", "code_information": [{"code": "100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG LOWER ABDOMEN", "code_information": [{"code": "840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG ON VAG/URETHRAL", "code_information": [{"code": "942", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF FEMUR", "code_information": [{"code": "1230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", 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"ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS EXPLORATION", "code_information": [{"code": "924", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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"standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG SURGERY", "code_information": [{"code": "1250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG VEINS SURG", "code_information": [{"code": "1260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM ARTERY SURG", "code_information": [{"code": "1770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM EMBOLECTOMY", "code_information": [{"code": "1772", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM PROCEDURE", "code_information": [{"code": "1730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1714", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM VEIN REPAIR", "code_information": [{"code": "1782", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL ENDOSCOPY", "code_information": [{"code": "950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL HYSTERECTOMY", "code_information": [{"code": "944", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL PROCEDURES", "code_information": [{"code": "940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR ACCESS", "code_information": [{"code": "532", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR SHUNT SURG", "code_information": [{"code": "1844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VASECTOMY", "code_information": [{"code": "921", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH VITREORETINAL SURG", "code_information": [{"code": "145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH WRIST REPLACEMENT", "code_information": [{"code": "1832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2428.31, "maximum": 4927.87, "discounted_cash": 6275.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3252.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3252.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4927.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4317.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2844.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2428.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3116.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIO FEM/POP W/ US", "code_information": [{"code": "C7531", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOCATH SPECIAL ORANGE 14GX5.25 10/BX 382269", "code_information": [{"code": "382269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 171.02, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN I ENZYME TEST", "code_information": [{"code": "82164", "type": "CPT"}], "standard_charges": [{"minimum": 13.14, "maximum": 584.01, "discounted_cash": 18.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29891", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 844.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 804.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29894", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29895", "type": "CPT"}], "standard_charges": [{"minimum": 581.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 581.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29897", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 620.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29898", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG&FIL", "code_information": [{"code": "62370", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 129.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.13, "maximum": 25.13, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 224.43, "maximum": 584.01, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 318.96, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 318.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"minimum": 254.38, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 254.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"minimum": 403.89, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 403.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 907.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 241.78, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 422.22, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 422.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 402.84, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 480.13, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 480.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 87.64, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 23.89, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 147.81, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 161.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 161.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 161.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2264.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2388.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 28.2, "maximum": 45.74, "discounted_cash": 40.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 747.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 747.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1372.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1372.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 121.29, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR CERVICAL PACK SNE21ACBWC", "code_information": [{"code": "SNE21ACBWC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.31, "setting": "both", "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY", "code_information": [{"code": "57240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.74, "methodology": "fee 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4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7132.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTERIOR INSTRUMENTATION 4 TO 7 VERTEBRAL SEG 22846", "code_information": [{"code": "22846", "type": "CPT"}, {"code": "1700062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee 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"ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-PHOSPHOLIPID ANTIBODY", "code_information": [{"code": "86148", "type": "CPT"}], "standard_charges": [{"minimum": 14.46, "maximum": 584.01, "discounted_cash": 20.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBODY DETECTION NOS IF", "code_information": [{"code": "87299", "type": "CPT"}], "standard_charges": [{"minimum": 14.49, "maximum": 584.01, "discounted_cash": 20.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SARS-COV-2 TITER(S)", "code_information": [{"code": "224U", "type": "CPT"}], "standard_charges": [{"minimum": 37.92, "maximum": 37.92, "discounted_cash": 66.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTICOAG MGMT PT WARFARIN", "code_information": [{"code": "93793", "type": "CPT"}], "standard_charges": [{"minimum": 15.93, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.42, "methodology": "fee 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"plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ACTIVITY", "code_information": [{"code": "85300", "type": "CPT"}], "standard_charges": [{"minimum": 10.67, "maximum": 584.01, "discounted_cash": 15.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ANTIGEN", "code_information": [{"code": "85301", "type": "CPT"}], "standard_charges": [{"minimum": 9.73, "maximum": 584.01, "discounted_cash": 14.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT 1ST GD", "code_information": [{"code": "561T", "type": "CPT"}], "standard_charges": [{"minimum": 74.26, "maximum": 80.31, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 80.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 74.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT 1ST 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"560T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29757.5, "maximum": 86453.84, "discounted_cash": 61497.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 57060.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 57060.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86453.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 75745.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49906.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 42601.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 29757.5, "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": 18569.2, "maximum": 53739.94, "discounted_cash": 37761.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35468.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35468.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53739.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47083.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31021.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26481.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18569.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 412.38, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total 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"plan_name": "OSCAR", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 453.6, "maximum": 735.84, "discounted_cash": 655.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 735.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1971.28, "discounted_cash": 1755.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1822.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1822.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1971.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1822.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1822.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1225.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 584.01, "discounted_cash": 260.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 702.0, "discounted_cash": 1014.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 584.01, "discounted_cash": 364.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 254.59, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 20.32, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2923.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 941.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 121.26, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 118.91, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 125.74, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIS, PER SQUARE CENTIMETER", "code_information": [{"code": "A2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APLIGRAF", "code_information": [{"code": "Q4101", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 123.3, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 19.14, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 46.58, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 65.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 25.91, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 19.57, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 33925.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1412.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2505.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1077.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 98.16, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1524.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6753.41, "maximum": 20830.57, "discounted_cash": 13533.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13748.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13748.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20830.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18250.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12024.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10264.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6753.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11058.42, "maximum": 30924.45, "discounted_cash": 21413.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20410.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20410.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30924.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27094.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17851.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15238.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11058.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5015.52, "maximum": 15321.82, "discounted_cash": 10235.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10112.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10112.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15321.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13423.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8844.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7550.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5015.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1203.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 20.17, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+LLLT PO PAIN", "code_information": [{"code": "97037", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 99.38, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 140.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 716.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 660.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 584.01, "maximum": 584.01, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION LONG LEG SPLINT", "code_information": [{"code": "29505", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 166.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOWER LEG SPLINT", "code_information": [{"code": "29515", "type": "CPT"}], "standard_charges": [{"minimum": 109.53, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 133.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 133.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 133.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 558.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 558.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 603.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 558.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 417.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 515.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 515.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 556.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 515.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 444.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 428.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 428.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 462.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 428.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 394.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 642.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 642.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 693.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 642.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 488.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 488.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 527.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 488.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 439.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 509.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 509.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 550.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 509.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 479.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 182.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 182.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 196.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 182.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29130", "type": "CPT"}], "standard_charges": [{"minimum": 61.13, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 78.86, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 103.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 78.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FOREARM CAST", "code_information": [{"code": "29075", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 454.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 454.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 491.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 454.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 374.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 543.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 270.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 270.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 291.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 270.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM CAST", "code_information": [{"code": "29065", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 177.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 177.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 192.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 177.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29345", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 252.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 252.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 273.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 252.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 284.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 204.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 227.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 227.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 246.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 227.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF MULTIPLANE UNILATERAL EXT. FIX. SYSTEM 20692", "code_information": [{"code": "20692", "type": "CPT"}, {"code": "1479955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1389.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 83.85, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 408.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 408.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 441.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 408.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 227.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 227.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 227.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 182.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF UNIPLANE UNILATERAL EXT. FIX. SYSTEM 20690", "code_information": [{"code": "20690", "type": "CPT"}, {"code": "1479956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 721.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 25.52, "maximum": 4936.0, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATOR 26ML CHLORHEXIDINE  TINTED  930825", "code_information": [{"code": "930825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.84, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORAPREP 3ML CLEAR 930400", "code_information": [{"code": "930400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.68, "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": 17.07, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.58, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML TEAL SCRUB CHLORAPREP LF", "code_information": [{"code": "260825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.19, "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": 320.98, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR COTTON-TIP WOOD 3 NS", "code_information": [{"code": "MDS202050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.02, "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": 954.9, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIED 12X150 NON BLADE", "code_information": [{"code": "CFF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.28, "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": 3659.31, "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": 167.87, "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": 294.79, "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": 204.16, "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": 141.38, "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": 86.83, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 109.88, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 145.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 145.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 157.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 145.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29125", "type": "CPT"}], "standard_charges": [{"minimum": 104.3, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 113.36, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 141.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 141.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 153.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 141.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 175.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 175.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 175.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RADIAT COMPL", "code_information": [{"code": "77778", "type": "CPT"}], "standard_charges": [{"minimum": 343.8, "maximum": 623.2, "discounted_cash": 870.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 343.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 343.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 371.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 343.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 343.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 623.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 335.3, "maximum": 584.01, "discounted_cash": 870.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 335.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 335.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 362.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 335.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 335.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 445.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 259.23, "maximum": 584.01, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 280.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 259.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 337.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 228.58, "maximum": 584.01, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 228.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 228.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 247.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 228.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 228.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 163.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 163.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 176.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 163.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 296.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 296.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 320.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 296.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 111.86, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2011.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 276.03, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 255.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 255.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 276.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 255.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 177.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 116.24, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 164.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 107.76, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 146.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 146.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 158.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 146.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 213.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 213.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 230.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 213.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 183.74, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 71.47, "maximum": 584.01, "discounted_cash": 127.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 49.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 40.81, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB CBA EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB ELISA", "code_information": [{"code": "86051", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 14.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY/EXERCISES", "code_information": [{"code": "97113", "type": "CPT"}], "standard_charges": [{"minimum": 50.53, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 50.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1315.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1250.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 271.22, "discounted_cash": 391.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 584.01, "discounted_cash": 391.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 439.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 584.01, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARCHITECT ECM PX FX 1 SQ CM", "code_information": [{"code": "Q4147", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2188.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1939.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2067.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2016.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1775.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1969.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1216.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1294.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1562.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1182.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1657.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1962.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1526.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1284.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1270.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2145.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2312.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2894.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2767.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2597.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2471.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2023.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1461.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1790.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1357.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1308.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1461.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1582.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1678.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1443.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1649.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2257.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1517.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1573.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1733.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2006.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1450.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1433.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1514.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1332.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1582.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2143.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2354.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1394.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1449.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2098.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1568.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1344.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1894.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1310.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1245.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1128.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1751.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 11.2, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1177.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1127.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC 1 SQ CM", "code_information": [{"code": "Q4190", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTACENT CORD PER SQ CM", "code_information": [{"code": "Q4216", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTACENT WOUND, PER SQ CM", "code_information": [{"code": "Q4169", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERIAL CATH. OR CANNULATION SAMPLING MONITOR/TRANSFUSIOIN PERCUTANEOUS 36620", "code_information": [{"code": "36620", "type": "CPT"}, {"code": "44626048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 56.28, "maximum": 4936.0, "gross_charge": 675.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 249.54, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 624.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 66.38, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 66.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 100.33, "maximum": 584.01, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 130.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 130.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 141.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 130.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 130.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 164.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 150.76, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 169.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 169.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 183.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 169.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 169.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 89.84, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 159.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 94.65, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 177.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 177.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 191.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 177.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 177.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 147.88, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 163.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 90.7, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 108.65, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 135.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 135.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 146.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 135.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 135.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 93.33, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 130.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 130.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 140.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 130.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 130.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 121.62, "maximum": 584.01, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 143.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 143.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 155.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 143.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 143.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 169.63, "maximum": 584.01, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 169.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 169.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 183.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 169.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 169.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 219.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 942.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "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": 584.01, "maximum": 14280.0, "gross_charge": 6771.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1659.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2602.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2062.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2463.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1559.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1954.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"minimum": 415.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 415.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2015.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2225.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2887.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2517.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1701.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1992.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 18061.44, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18061.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.56, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRO/SHOUL SURG; W/SPACER", "code_information": [{"code": "C9781", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 74.93, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 74.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANT. INTER W/DISC PREP/DISCECTOMY/OSTEO W/DEC CERVICAL BEL C2 EA ADD SP 22552", "code_information": [{"code": "22552", "type": "CPT"}, {"code": "1643968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 452.93, "maximum": 14280.0, "gross_charge": 6771.0, "estimated_discounted_cash": 6771.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 452.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY CERVICAL BELOW C2 22551", "code_information": [{"code": "22551", "type": "CPT"}, {"code": "1479982", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 14280.0, "gross_charge": 10159.0, "discounted_cash": 16052.22, "estimated_discounted_cash": 23111.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 4063.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 6095.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 6603.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2063.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY/INCL MIN. DISCECTOMY ; EA ADDTL INTERSPACE 22585", "code_information": [{"code": "22585", "type": "CPT"}, {"code": "1653278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 371.69, "maximum": 9086.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 9086.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 371.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODY/INCL MIN. DISCECTOMY ; LUMBAR 22558", "code_information": [{"code": "22558", "type": "CPT"}, {"code": "1480967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 6771.0, "discounted_cash": 33925.68, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1851.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR INTERBODYBODY 22554", "code_information": [{"code": "22554", "type": "CPT"}, {"code": "1479981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 9086.0, "gross_charge": 6771.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 9086.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 8429.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 7723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 8429.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1565.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR SPINAL DEFORMITY W/ OR W/W CAST 2 TO 3 VERTEBRAL  22808", "code_information": [{"code": "22808", "type": "CPT"}, {"code": "1700127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2265.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS COMB. POSTERIOR INTERBODY TECH . W/LAMI OR DISC SIN. LUM. 22633", "code_information": [{"code": "22633", "type": "CPT"}, {"code": "1792992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 14280.0, "gross_charge": 6771.0, "discounted_cash": 33925.68, "estimated_discounted_cash": 25108.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2190.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JT", "code_information": [{"code": "23800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1249.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1896.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST INTERBODY TECH W/LAMI OR DISCECTOMY PREP INTERSP 22632", "code_information": [{"code": "22632", "type": "CPT"}, {"code": "1653281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 367.19, "maximum": 14280.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST. TECH. ATLAS AXIS C1/C2 22595", "code_information": [{"code": "22595", "type": "CPT"}, {"code": "1807655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 6771.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1916.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST/POSTEROLATERAL TECH. W/POST. INT. TECH INC. LAMI/DISCECTOMY  EA. ADD. SPACE  22634", "code_information": [{"code": "22634", "type": "CPT"}, {"code": "2401823", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 554.32, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 554.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POSTERIOR POSTEROLATERAL TECH EA ADD VERT 22614", "code_information": [{"code": "22614", "type": "CPT"}, {"code": "1653277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 448.16, "maximum": 4936.0, "gross_charge": 4737.0, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SACROILIAC JT. PERCUT. OR MIN. INV. W/IMAGE INC. TRANSFIX DEVICE 27279", "code_information": [{"code": "27279", "type": "CPT"}, {"code": "41282644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 14280.0, "gross_charge": 4737.0, "discounted_cash": 21922.55, "estimated_discounted_cash": 15464.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, 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"standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", 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"plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 764.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [{"code": "24006", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 878.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW EXPL DRG/RMVL FB", "code_information": [{"code": "24000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 608.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW JT EXPL BX RMVL", "code_information": [{"code": "24101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 637.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW SYNOVIAL BX ONLY", "code_information": [{"code": "24100", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 541.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 110.96, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 123.0, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4103.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2963.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASAY OF INTERLEUKIN-6 (IL-6)", "code_information": [{"code": "83529", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 584.01, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3806.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3886.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 10X63/67", "code_information": [{"code": "179310", "type": "CDM"}], "standard_charges": [{"gross_charge": 176.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 12X59", "code_information": [{"code": "179301", "type": "CDM"}], "standard_charges": [{"gross_charge": 194.18, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 16X59", "code_information": [{"code": "179303", "type": "CDM"}], "standard_charges": [{"gross_charge": 188.92, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCENT PRI LIP BRG 20X59", "code_information": [{"code": "179305", "type": "CDM"}], "standard_charges": [{"gross_charge": 194.18, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCOPE 4 SLIM 476101000", "code_information": [{"code": "476101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1014.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2203.7, "discounted_cash": 3183.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 872.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPA GENE", "code_information": [{"code": "81200", "type": "CPT"}], "standard_charges": [{"minimum": 42.53, "maximum": 584.01, "discounted_cash": 61.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AG IA", "code_information": [{"code": "87305", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS ANTIBODY", "code_information": [{"code": "86606", "type": "CPT"}], "standard_charges": [{"minimum": 13.55, "maximum": 584.01, "discounted_cash": 19.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"minimum": 413.35, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/O IMAGING", "code_information": [{"code": "32554", "type": "CPT"}], "standard_charges": [{"minimum": 345.49, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE/INJ GANGLION CYST", "code_information": [{"code": "20612", "type": "CPT"}], "standard_charges": [{"minimum": 90.24, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION INTERMEDIATE JOINT/BURSA W/O ULTRASOUND GUIDANCE 20605", "code_information": [{"code": "20605", "type": "CPT"}, {"code": "1480131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 76.33, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"minimum": 112.74, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATION/INJECTION  MAJOR JOINT/BURSA W/O ULTRASOUND GUIDANCE 20610", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "1480132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 91.24, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case 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PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY 17- KETOSTEROIDS", "code_information": [{"code": "83586", "type": "CPT"}], "standard_charges": [{"minimum": 11.52, "maximum": 584.01, "discounted_cash": 16.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ACID PHOSPHATASE", "code_information": [{"code": "84060", "type": "CPT"}], "standard_charges": [{"minimum": 6.88, "maximum": 584.01, "discounted_cash": 9.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ACTIVATED PROTEIN C", "code_information": [{"code": "85307", "type": "CPT"}], "standard_charges": [{"minimum": 13.79, "maximum": 584.01, "discounted_cash": 19.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 7.43, "maximum": 584.01, "discounted_cash": 10.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASES", "code_information": [{"code": "84080", "type": "CPT"}], "standard_charges": [{"minimum": 13.3, "maximum": 584.01, "discounted_cash": 19.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY AMINOLEVULINIC ACID", "code_information": [{"code": "82135", "type": "CPT"}], "standard_charges": [{"minimum": 14.81, "maximum": 584.01, "discounted_cash": 21.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ANTI-MULLERIAN HORM", "code_information": [{"code": "82166", "type": "CPT"}], "standard_charges": [{"minimum": 34.76, "maximum": 584.01, "discounted_cash": 50.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CARBON DIOXIDE", "code_information": [{"code": "82374", "type": "CPT"}], "standard_charges": [{"minimum": 4.39, "maximum": 584.01, "discounted_cash": 6.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.74, "methodology": "fee 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"standard_charge_dollar": 26.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY C-D TRANSFER MEASURE", "code_information": [{"code": "82373", "type": "CPT"}], "standard_charges": [{"minimum": 16.25, "maximum": 584.01, "discounted_cash": 23.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUAL", "code_information": [{"code": "82376", "type": "CPT"}], "standard_charges": [{"minimum": 11.04, "maximum": 584.01, "discounted_cash": 18.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - 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"standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TEST FOR BLOOD FECAL", "code_information": [{"code": "82274", "type": "CPT"}], "standard_charges": [{"minimum": 14.33, "maximum": 584.01, "discounted_cash": 20.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.33, "methodology": "fee schedule"}], 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"standard_charge_dollar": 48.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TOXIN OR ANTITOXIN", "code_information": [{"code": "87230", "type": "CPT"}], "standard_charges": [{"minimum": 17.77, "maximum": 584.01, "discounted_cash": 25.66, "setting": "outpatient", 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"plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSEMBLY BLADE REPROCESS SMARTRELEASE ECTRINSTR DISP", "code_information": [{"code": "81010R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 367.64, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSESS CYST CONTRAST INJECT", "code_information": [{"code": "49424", "type": "CPT"}], "standard_charges": [{"minimum": 226.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSMT & CARE PLN PT COG IMP", "code_information": [{"code": "99483", "type": "CPT"}], "standard_charges": [{"minimum": 395.96, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 395.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AST", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "633633", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.66, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 6.73, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"discounted_cash": 879.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 954.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 954.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1032.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 954.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 954.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASXL1 GENE TARGET SEQ ALYS", "code_information": [{"code": "81176", "type": "CPT"}], "standard_charges": [{"minimum": 217.71, "maximum": 584.01, "discounted_cash": 314.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 403.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 403.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 436.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 403.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 403.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY CARBAMAZEPIN 10,11-EPXID", "code_information": [{"code": "80161", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYCORTICOSTEROIDS17", "code_information": [{"code": "83491", "type": "CPT"}], "standard_charges": [{"minimum": 16.11, "maximum": 584.01, "discounted_cash": 23.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYPROGESTERONE 17-D", "code_information": [{"code": "83498", "type": "CPT"}], "standard_charges": [{"minimum": 24.45, "maximum": 584.01, "discounted_cash": 35.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 50.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 50.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY THIOPURIN S-MTHYLTRNSFRS", "code_information": [{"code": "84433", "type": "CPT"}], "standard_charges": [{"minimum": 19.95, "maximum": 584.01, "discounted_cash": 28.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITH MCC", "code_information": [{"code": "302", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5191.81, "maximum": 27311.14, "discounted_cash": 10699.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18025.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18025.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27311.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23928.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15765.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13458.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5191.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [{"code": "303", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3000.92, "maximum": 17566.89, "discounted_cash": 6019.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11594.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11594.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17566.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15390.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10140.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8656.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3000.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL HIGH CMPLX", "code_information": [{"code": "97171", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL LOW CMPLX", "code_information": [{"code": "97169", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL MOD CMPLX", "code_information": [{"code": "97170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN RE-EVAL PLAN CR", "code_information": [{"code": "97172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATM MRNA SEQ ALYS", "code_information": [{"code": "136U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 366.69, "discounted_cash": 529.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 366.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 366.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATN1 GENE DETC ABNOR ALLELES", "code_information": [{"code": "81177", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOMIC ABSORPTION", "code_information": [{"code": "82190", "type": "CPT"}], "standard_charges": [{"minimum": 14.31, "maximum": 584.01, "discounted_cash": 20.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE 1% 3.5 GM OPTH OINTMENT", "code_information": [{"code": "MED0011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1108.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1624.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1624.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3220.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3220.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1094.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTENDANCE AT DELIVERY", "code_information": [{"code": "99464", "type": "CPT"}], "standard_charges": [{"minimum": 87.89, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 146.75, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 228.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 228.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 246.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 228.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD REHAB POSTLING HEAR LOSS", "code_information": [{"code": "92633", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD REHAB PRE-LING HEAR LOSS", "code_information": [{"code": "92630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "209T", "type": "CPT"}], "standard_charges": [{"minimum": 90.0, "maximum": 97.2, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 97.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 64.18, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 64.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR ONLY", "code_information": [{"code": "208T", "type": "CPT"}], "standard_charges": [{"minimum": 49.56, "maximum": 53.52, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST 15-30 MIN", "code_information": [{"code": "99408", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST OVER 30 MIN", "code_information": [{"code": "99409", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"minimum": 29.11, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"minimum": 121.98, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 193.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1458.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3428.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5232.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2198.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1291.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ CPTR ALYS", "code_information": [{"code": "625T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ I&R", "code_information": [{"code": "626T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1972.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOGRAFT FOR SPINAL SURGERY ONLY W/HARVEST OF GRAFT LOCAL MORSELIZED 20937", "code_information": [{"code": "20937", "type": "CPT"}, {"code": "1956285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 190.85, "maximum": 4936.0, "gross_charge": 4737.0, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL BICORTICAL OR TIRCORTICAL 20938", "code_information": [{"code": "20938", "type": "CPT"}, {"code": "2334787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 209.78, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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"plan_name": "OSCAR", "standard_charge_dollar": 209.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 862.29, "discounted_cash": 1092.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 797.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 797.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 862.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 797.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 797.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD PROCESS", "code_information": [{"code": "86890", "type": "CPT"}], "standard_charges": [{"minimum": 84.69, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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"discounted_cash": 48572.16, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 26938.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOMATED DIFF WBC COUNT", "code_information": [{"code": "85004", "type": "CPT"}], "standard_charges": [{"minimum": 5.82, "maximum": 584.01, "discounted_cash": 8.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED LEUKOCYTE COUNT", "code_information": [{"code": "85048", "type": "CPT"}], "standard_charges": [{"minimum": 2.29, "maximum": 584.01, "discounted_cash": 3.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RBC COUNT", "code_information": [{"code": "85041", "type": "CPT"}], "standard_charges": [{"minimum": 2.72, "maximum": 584.01, "discounted_cash": 3.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RETICULOCYTE COUNT", "code_information": [{"code": "85045", "type": "CPT"}], "standard_charges": [{"minimum": 3.59, "maximum": 584.01, "discounted_cash": 5.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.96, "methodology": "fee 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SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 103.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 103.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 111.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 103.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 60.23, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 103.58, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 310.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 287.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 103.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88020", "type": "CPT"}], "standard_charges": [{"minimum": 321.24, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88025", "type": "CPT"}], "standard_charges": [{"minimum": 310.84, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88028", "type": "CPT"}], "standard_charges": [{"minimum": 186.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88029", "type": "CPT"}], "standard_charges": [{"minimum": 186.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88000", "type": "CPT"}], "standard_charges": [{"minimum": 186.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88005", "type": "CPT"}], "standard_charges": [{"minimum": 217.62, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 217.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 217.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88007", "type": "CPT"}], "standard_charges": [{"minimum": 228.02, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 228.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 228.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88012", "type": "CPT"}], "standard_charges": [{"minimum": 186.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88014", "type": "CPT"}], "standard_charges": [{"minimum": 170.85, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 170.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 170.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88016", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 279.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 279.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 962.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 900.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 822.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 785.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 867.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVITENE 1 GM MICROFIBRILLAR COLLAGEN HEMOSTAT", "code_information": [{"code": 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"billing_class": "facility"}]}, {"description": "BAG DRAIN 2LT CENTER ENTRY ANTI REFLUX DEV LF", "code_information": [{"code": "153504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRAINAGE 4000 ML UROLOGY ANTI REFLUX", "code_information": [{"code": "153509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG DRN 32OZ ANTI REFLUX FLIPFLO VALVE LEG STRP VINYL FLIPFLO LF STRL", "code_information": [{"code": "150732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG EVA 4000ML EXACTAMIX", "code_information": [{"code": "H938742", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG EVA EMPTY EXACTAMIX 4000ML FOR 3-IN-1 LIPID CONTAINING SOLUTIONS", "code_information": [{"code": "H938142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG ISOLATION INVISISHIELD 20IN X 20IN", "code_information": [{"code": "DYNJSD1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG RBC 400 ML REPLACE", "code_information": [{"code": "1200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG RESUSCITATOR MASK RESERVOIR ADLT", "code_information": [{"code": "8500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPECIMEN RETRIEVAL 224 ML DISP STRL POUCH", "code_information": [{"code": "POUCH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 238.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPIKE SMARTSITE 0.51ML", "code_information": [{"code": ".00E+00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPIKE W/ SMARTSITE NEEDLE", "code_information": [{"code": "H93893", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG SPONGE COUNTER BLUE 50/BX 5BX/CS", "code_information": [{"code": "DYNJE1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG WASTE 3LT REPLACE", "code_information": [{"code": "1300-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG WASTE 3LTR", "code_information": [{"code": "1300-0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BAGS EODMAN EDS COLLECTION J-J821732", "code_information": [{"code": "J-J821732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIR PAWS WARMING GOWN ADULT STANDARD 81001", "code_information": [{"code": "81001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1048.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON PDB STERILE KIDNEY-SHAPE OMS-PDBS2", "code_information": [{"code": "OMS-PDBS2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PREPERITONEAL DIST OMSPDB1000", "code_information": [{"code": "OMSPDB1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIALYSIS SEG", "code_information": [{"code": "36907", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 763.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAND TOURNIQUET 1IN X 18IN BLUE ROLLED BANDED LF", "code_information": [{"code": "DYND75020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHESIVE 2YD X 6.0IN COVER-ROLL", "code_information": [{"code": "45549", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 28.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHESIVE PLASTIC 3 4X3 STRL LF NON25500", "code_information": [{"code": "NON25500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ADHSV 1IN X 3IN FLEXIBLE CURITY", "code_information": [{"code": "44101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE CONFORM STRETCH 3X75 STRL", "code_information": [{"code": "2232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC 6IN ESMARK LF", "code_information": [{"code": "99304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.79, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELASTIC MATRIX 6X5YD SELF CLSR MDS087006LF", "code_information": [{"code": "MDS087006LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 6IN X 15YD WHT BEIGE WND MED COMPRESSION COLOR CODED POLYESTER COT", "code_information": [{"code": "DYNJ05158LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 6IN X 5YD WHT BEIGE WND MED COMPRESSION COLOR CODED POLYESTER COTT", "code_information": [{"code": "DYNJ05156LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE ELSTC 6IN X 9FT EVEN COMPRESSION SMOOTH FINISH PROTECTS FRAGILE SKIN ES", "code_information": [{"code": "DYNJ05918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 4 1/2IN X 4 1/10YD FLUFF BULKEE II STRL", "code_information": [{"code": "NON25865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE GAUZE 4IN X 4 1/10YD STRETCHED BULKEE LITE STRL", "code_information": [{"code": "NON27498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.01, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SELF ADHERENT 2X5YD LF NS 36EA/B", "code_information": [{"code": "CAH25LF", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SLF ADHERENT 3IN X 5YD TAN COBAN LF STRL", "code_information": [{"code": "2083S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.57, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE SLF ADHERENT 6IN X 5YD TAN WRAP COBAN LF STRL", "code_information": [{"code": "2086S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 1IN X 5IN SKIN CLOSURE STRIP ADHSV NON WOVEN COATED BACKING STERI-ST", "code_information": [{"code": "R1548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE WND 4IN X 5YD WHT BEIGE VELCRO CLOSURE MED COMPRESSION ELSTC POLYESTER C", "code_information": [{"code": "MDS087004LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.58, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGE.ESMARK LATEX FREE 4X9 CTM UMMS 99301", "code_information": [{"code": "99301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BANDAGES CURAD COMFORT ADHESIVE NON25744", "code_information": [{"code": "NON25744", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BARRERA SLOR DL PER SQ CM", "code_information": [{"code": "Q4281", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA ANTIBODY", "code_information": [{"code": "86611", "type": "CPT"}], "standard_charges": [{"minimum": 9.16, "maximum": 584.01, "discounted_cash": 13.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA AMP PROBE", "code_information": [{"code": "87471", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA QUANT", "code_information": [{"code": "87472", "type": "CPT"}], "standard_charges": [{"minimum": 38.56, "maximum": 584.01, "discounted_cash": 55.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC LIFE DISABILITY EXAM", "code_information": [{"code": "99450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC VESTIBULAR EVALUATION", 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETAMETHASONE (CELESTONE SOLUSPAN) 30MG/5ML VIAL", "code_information": [{"code": "MED0028", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 132.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BFB TRAINING 1ST 15 MIN", "code_information": [{"code": "90912", "type": "CPT"}], "standard_charges": [{"minimum": 110.75, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 151.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 151.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 163.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 151.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING EA ADDL 15 MIN", "code_information": [{"code": "90913", "type": "CPT"}], "standard_charges": [{"minimum": 44.99, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID ASSMT BY PHYS/QHP", "code_information": [{"code": "97151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT BY 1 TECH", "code_information": [{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIA WHOLE BODY", "code_information": [{"code": "358T", "type": "CPT"}], "standard_charges": [{"minimum": 63.6, "maximum": 68.69, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [{"code": "461", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26009.41, "maximum": 52781.89, "discounted_cash": 49383.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34836.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34836.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 52781.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46244.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30468.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26009.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 27388.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "462", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12781.14, "maximum": 42661.86, "discounted_cash": 23784.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28157.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28157.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42661.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37377.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24627.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21022.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12781.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 23.92, "maximum": 584.01, "discounted_cash": 34.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}], "standard_charges": [{"minimum": 15.41, "maximum": 584.01, "discounted_cash": 22.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 190.17, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2113.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 345.85, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 343.56, "maximum": 6923.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 343.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 535.95, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 409.1, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 409.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 463.59, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 463.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [{"code": "409", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9356.68, "maximum": 35457.26, "discounted_cash": 19468.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23402.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23402.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35457.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31065.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20468.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17472.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9356.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15626.3, "maximum": 112128.31, "discounted_cash": 31881.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74005.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74005.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112128.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98239.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64727.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 55253.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15626.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "410", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6922.56, "maximum": 19860.14, "discounted_cash": 14196.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13107.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13107.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19860.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17400.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11464.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9786.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6922.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}], "standard_charges": [{"minimum": 4.52, "maximum": 584.01, "discounted_cash": 6.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL TRANSCUT", "code_information": [{"code": "88720", "type": "CPT"}], "standard_charges": [{"minimum": 4.52, "maximum": 584.01, "discounted_cash": 6.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1968.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BINDER ABD 10INCH", "code_information": [{"code": "78-89047", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL LG 10IN WHT SACRO LUMBAR", "code_information": [{"code": "79-89047", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL MED 10IN WHT SACRO LUMBAR", "code_information": [{"code": "79-89045", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL SM 10IN WHT SACRO LUMBAR", "code_information": [{"code": "79-89043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL UNIVERSAL 9IN 30 TO 45IN HOOK AND LOOP CLOSURE ELASTIC PROCARE", "code_information": [{"code": "79-89070", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 36.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABDOMINAL XL 10IN WHT SACRO LUMBAR", "code_information": [{"code": "79-89048", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIO-CONNEKT PER SQUARE CM", "code_information": [{"code": "Q4161", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIODFENCE 1CM", "code_information": [{"code": "Q4140", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIODFENCE DRYFLEX, 1CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 55.47, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"minimum": 35.29, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10437.17, "maximum": 43687.36, "discounted_cash": 21988.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28833.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28833.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43687.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38276.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25219.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21527.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10437.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15348.26, "maximum": 58486.11, "discounted_cash": 30888.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38601.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38601.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 58486.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51241.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33761.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 28820.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15348.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7925.4, "maximum": 24409.47, "discounted_cash": 16621.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16110.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16110.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24409.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21386.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14090.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12028.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7925.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ABDOMINAL MASS", "code_information": [{"code": "49180", "type": "CPT"}], "standard_charges": [{"minimum": 227.46, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24065", "type": "CPT"}], "standard_charges": [{"minimum": 347.78, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 347.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24066", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 901.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE 20220", "code_information": [{"code": "20220", "type": "CPT"}, {"code": "1480143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 296.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE; OPEN; DEEP 20245", "code_information": [{"code": "20245", "type": "CPT"}, {"code": "1480144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 404.37, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 404.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE; OPEN; SUPERFICIAL 20240", "code_information": [{"code": "20240", "type": "CPT"}, {"code": "1480145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 171.68, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"minimum": 219.53, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 219.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYELID & LID MARGIN", "code_information": [{"code": "67810", "type": "CPT"}], "standard_charges": [{"minimum": 240.37, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "type": "CPT"}], "standard_charges": [{"minimum": 448.14, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26110", "type": "CPT"}], "standard_charges": [{"minimum": 420.21, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 420.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps 129-0175 Oval Yellow 160 2", "code_information": [{"code": "BF40021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps 129-0181 Alligator Yellow 160 2", "code_information": [{"code": "BF40141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps With Spike 129-0176 Oval Yellow 160 2", "code_information": [{"code": "BF40051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 128-5668 Oval Blue 230 2.8", "code_information": [{"code": "BF40096", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 128-5670 Alligator Blue 230 2.8", "code_information": [{"code": "BF40206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0179 Oval Orange 180 2.8", "code_information": [{"code": "BF40081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0184 Alligator Orange 180 2.8", "code_information": [{"code": "BF40191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0677 Oval Blue 230 2.8", "code_information": [{"code": "BF40091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0679 Alligator Blue 230 2.8", "code_information": [{"code": "BF40201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 131-2212 Serrated Blue 230 2.8", "code_information": [{"code": "BF40446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 132-9017 Serrated Blue 230 2.8", "code_information": [{"code": "BF40441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 132-9020 Serrated Orange 180 2.8", "code_information": [{"code": "BF40431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5669 Oval Blue 230 2.8", "code_information": [{"code": "BF40126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5671 Alligator Blue 230 2.8", "code_information": [{"code": "BF40236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0180 Oval Orange 180 2.8", "code_information": [{"code": "BF40111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0185 Alligator Orange 180 2.", "code_information": [{"code": "BF40221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0678 Oval Blue 230 2.8", "code_information": [{"code": "BF40121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0680 Alligator Blue 230 2.8", "code_information": [{"code": "BF40231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated  131-2211 Serrated Blue", "code_information": [{"code": "BF40426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated  132-9019 Serrated Blue", "code_information": [{"code": "BF40421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated 132-9018 Serrated Orang", "code_information": [{"code": "BF40411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0177 Oval Blue 230 3.2", "code_information": [{"code": "BF40061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0182 Alligator Blue 230 3.2", "code_information": [{"code": "BF40171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps With Spike 129-0178 Oval Blue 230 3.2", "code_information": [{"code": "BF40071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forcep Hot Lower 129-0681 Oval Blue 230 2.8", "code_information": [{"code": "HF48521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forceps Hot Lower Alligator 131-2213 Alligator Blue 230 2.8", "code_information": [{"code": "HF48541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25065", "type": "CPT"}], "standard_charges": [{"minimum": 346.95, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 346.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 473.31, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 473.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY HAND JOINT LINING", "code_information": [{"code": "26100", "type": "CPT"}], "standard_charges": [{"minimum": 446.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY KNEE JOINT LINING", "code_information": [{"code": "27330", "type": "CPT"}], "standard_charges": [{"minimum": 543.79, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27613", "type": "CPT"}], "standard_charges": [{"minimum": 345.92, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27614", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 808.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY LYMPH NODE OPEN SUPERFICIAL 38500", "code_information": [{"code": "38500", "type": "CPT"}, {"code": "1480157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 484.31, "maximum": 4936.0, "gross_charge": 2130.0, "discounted_cash": 4895.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 852.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1278.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1384.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 484.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE DEEP 20205", "code_information": [{"code": "20205", "type": "CPT"}, {"code": "1480159", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 442.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE SUPERFICIAL 20200", "code_information": [{"code": "20200", "type": "CPT"}, {"code": "1480160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 160.12, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BOWEL", "code_information": [{"code": "44100", "type": "CPT"}], "standard_charges": [{"minimum": 124.79, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BREAST OPEN", "code_information": [{"code": "19101", "type": "CPT"}], "standard_charges": [{"minimum": 458.92, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 458.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX", "code_information": [{"code": "57500", "type": "CPT"}], "standard_charges": [{"minimum": 200.14, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 200.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX W/SCOPE", "code_information": [{"code": "57455", "type": "CPT"}], "standard_charges": [{"minimum": 213.08, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 213.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA", "code_information": [{"code": "65410", "type": "CPT"}], "standard_charges": [{"minimum": 193.0, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 193.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS", "code_information": [{"code": "54800", "type": "CPT"}], "standard_charges": [{"minimum": 150.72, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR", "code_information": [{"code": "69100", "type": "CPT"}], "standard_charges": [{"minimum": 123.48, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 123.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR CANAL", "code_information": [{"code": "69105", "type": "CPT"}], "standard_charges": [{"minimum": 190.36, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID LINING", "code_information": [{"code": "68100", "type": "CPT"}], "standard_charges": [{"minimum": 239.79, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}], "standard_charges": [{"minimum": 224.85, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 545.83, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 545.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 511.06, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 563.55, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 733.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP", "code_information": [{"code": "40490", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF MOUTH LESION", "code_information": [{"code": "40808", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NECK/CHEST", "code_information": [{"code": "21550", "type": "CPT"}], "standard_charges": [{"minimum": 360.04, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 360.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE 64795", "code_information": [{"code": "64795", "type": "CPT"}, {"code": "1480169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 241.38, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY(S)", "code_information": [{"code": "58900", "type": "CPT"}], "standard_charges": [{"minimum": 517.98, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 517.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1104.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}], "standard_charges": [{"minimum": 270.72, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54105", "type": "CPT"}], "standard_charges": [{"minimum": 382.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 382.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55705", "type": "CPT"}], "standard_charges": [{"minimum": 310.15, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 310.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF RECTUM", "code_information": [{"code": "45100", "type": "CPT"}], "standard_charges": [{"minimum": 399.51, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 399.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"minimum": 526.39, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 526.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42400", "type": "CPT"}], "standard_charges": [{"minimum": 126.23, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 408.39, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 453.11, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 453.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1043.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR GLAND", "code_information": [{"code": "68510", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 604.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"minimum": 283.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}], "standard_charges": [{"minimum": 90.75, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54505", "type": "CPT"}], "standard_charges": [{"minimum": 260.3, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THROAT", "code_information": [{"code": "42800", "type": "CPT"}], "standard_charges": [{"minimum": 212.09, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 145.9, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 478.95, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 478.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41100", "type": "CPT"}], "standard_charges": [{"minimum": 249.13, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41105", "type": "CPT"}], "standard_charges": [{"minimum": 251.36, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42804", "type": "CPT"}], "standard_charges": [{"minimum": 284.68, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 284.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 318.25, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 318.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF URETHRA", "code_information": [{"code": "53200", "type": "CPT"}], "standard_charges": [{"minimum": 221.87, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UTERUS LINING", "code_information": [{"code": "58100", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 130.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57100", "type": "CPT"}], "standard_charges": [{"minimum": 139.1, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 139.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"minimum": 231.38, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56605", "type": "CPT"}], "standard_charges": [{"minimum": 124.31, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 51.98, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF WRIST JOINT", "code_information": [{"code": "25100", "type": "CPT"}], "standard_charges": [{"minimum": 457.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 457.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ROOF OF MOUTH", "code_information": [{"code": "42100", "type": "CPT"}], "standard_charges": [{"minimum": 199.18, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23065", "type": "CPT"}], "standard_charges": [{"minimum": 306.94, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23066", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 822.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21920", "type": "CPT"}], "standard_charges": [{"minimum": 349.53, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 349.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27323", "type": "CPT"}], "standard_charges": [{"minimum": 364.9, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 364.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27324", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 529.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY VERTEBRA CERVICAL OR LUMBAR 20251", "code_information": [{"code": "20251", "type": "CPT"}, {"code": "1480195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY VERTEBRA THORACIC OPEN 20250", "code_information": [{"code": "20250", "type": "CPT"}, {"code": "1480196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 4090.98, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 503.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 581.24, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 581.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38525", "type": "CPT"}], "standard_charges": [{"minimum": 562.97, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 562.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOVANCE 1 SQUARE CM", "code_information": [{"code": "Q4154", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOVANCE TRI OR 3L, SQ CM", "code_information": [{"code": "Q4283", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIS XTRACELL FLUID ANALYSIS", "code_information": [{"code": "93702", "type": "CPT"}], "standard_charges": [{"minimum": 173.46, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 205.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 205.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 221.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 205.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIT CUTTING TROCHLEA PARTIAL KNEE", "code_information": [{"code": "2024-61-010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 707.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.3MM X 15 CM FLUTED MATCHSTICK", "code_information": [{"code": "MA15-8N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.4MM QC", "code_information": [{"code": "7756010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM MATCH HEAD DIAMOND MIDAS REXINSTR", "code_information": [{"code": "T12MH25D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 428.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.5MM MATCH HEAD MIDAS REXINSTR", "code_information": [{"code": "T12MH25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 428.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.7MM X 160MM CANNULATED QUICK COUPLINGINSTR REPROCESS", "code_information": [{"code": "310.67R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 2.8MM 80-0387", "code_information": [{"code": "80-0387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM 170MM CANNULATED REPROCESS", "code_information": [{"code": "310.65R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 773.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM TAPERED", "code_information": [{"code": "F3/9TA30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 20MM QUICK CONNECT RINGLOC", "code_information": [{"code": "31-323220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3.2MM X 30MM QUICK CONNECT ORTHO RINGLOC", "code_information": [{"code": "31-323230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 3MM X 18.3MM METAL CUTTER LEGENDINSTR", "code_information": [{"code": "MC30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL ZEPHYR 11MM", "code_information": [{"code": "8796909", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT MILLING MIDAS REX DRILL", "code_information": [{"code": "3.820.153S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1592.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BITE BLOCK TONGUE DEPRESSOR TOOTHETTE STYROFOAM DISPOSABLE  4000", "code_information": [{"code": "4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BKK 10ML SYRINGE: KETOROLAC 30MG/ML (.34ML), KETAMINE 10MG/ML (1M), Marcaine 0.5% W EPI 5ML, BACTERI", "code_information": [{"code": "MED0030", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK 150 MG-60 MG-60 MG/50 ML INJ SOLN", "code_information": [{"code": "MED0844", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK 60ML SYRINGE: KETOROLAC 30GM/ML (2ML), KETAMINE 10MG/ML  (6ML), MARCAINE 0.5% WEPI 30ML, BACTERI", "code_information": [{"code": "MED0029", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK FOR PAIN PUMP NO TORADOL: MARCAINE W/EPI 0.125%, KETAMINE 1MG/ML", "code_information": [{"code": "MED0453", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BKK FOR PAIN PUMP: MARCAINE W/ EPI 0.125%, KETAMINE 1MG/ML", "code_information": [{"code": "MED0308", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BL DONOR SEARCH MANAGEMENT", "code_information": [{"code": "38204", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"minimum": 37.16, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"minimum": 24.69, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", 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FLARED 32.5 X 61.0 X 1.02MM", "code_information": [{"code": "2108-197-000S5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW SAGITTAL SS 21X90X1.19MM 6221-119-090", "code_information": [{"code": "6221-119-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW SAGITTAL THIN WITH WIDE FLARE", "code_information": [{"code": "2108-197-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM END CUTTER REPROCESS AGGRESSIVE PLUS", "code_information": [{"code": "375-534-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM GREY ARTHROSCOPIC REPROCESSINCISOR STRL DISP", "code_information": [{"code": "7205312R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5MM WHT GREAT REPROCESSINSTR", "code_information": [{"code": "9399AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM FULL RADIUS LG HUB REPROCESSINSTR", "code_information": [{"code": "9247AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM GATOR LG HUB REPROCESSINSTR", "code_information": [{"code": "9263AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 4.2MM WHT GREAT LG HUB REPROCESSINSTR", "code_information": [{"code": "9299AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 5.5MM WHT GREAT LG HUB REPROCESSINSTR", "code_information": [{"code": "9599AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHUVER 6MM OVAL BURR REPROCESSINSTR", "code_information": [{"code": "H9102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 3.5MM X 7CM BEIGE ARTHROSCOPIC STR REPROCESS DYONICS STRLINSTR DISP", "code_information": [{"code": "7205305R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM LIME GRN STRINCISOR REPROCESS STRLINSTR DISP", "code_information": [{"code": "7205313R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM NAVY BLUE STR TURBOWHISKER ARTHROSCOPIC REPROCESS DYONICS STRL", "code_information": [{"code": "7209303R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4.5MM YELLOW STR FULL RADIUS REPROCESS DYONICS STRLINSTR DISP", "code_information": [{"code": "7205306R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM LILAC STR REPROCESS NOTCHBLASTER STRLINSTR DISP", "code_information": [{"code": "7205328R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 4MM SAGE GRN STR REPROCESS ACROMIOBLASTER DYONICS STRLINSTR DISP", "code_information": [{"code": "7205668R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 5.5MM OLIVE STR ARTHROSCOPIC REPROCESS STONECUTTER STRLINSTR DISP", "code_information": [{"code": "7205331R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHVR 5.5MM TEAL STR ARTHROSCOPIC REPROCESS DYONICS STRL DISP", "code_information": [{"code": "7205459R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STAINLESS-STEEL 22 STERILE DISP", "code_information": [{"code": "MDS15122", "type": "CDM"}], "standard_charges": [{"gross_charge": 1.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4.2MM LG HUB REPROCESS CUDAINSTR", "code_information": [{"code": "C9254R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 4MM OVAL BURR LG HUB REPROCESSINSTR", "code_information": [{"code": "H9101RHR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.11, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG 84MM X 5MM LNG STRAIGHT SICKLE EDGE TYMPANOPLASTY OPHTHALMIC ARTHRO-L", "code_information": [{"code": "377300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.62, "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": 11.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL CLIPPER STANDARD PREP CAH4406D", "code_information": [{"code": "CAH4406D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL STAINLESS 22 STERILE 371222", "code_information": [{"code": "371222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TONGUE DEPRESSOR 6 NS", "code_information": [{"code": "C15063006A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "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": 1171.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES MEDLINE SURGICAL CLIPPER  UBLADEFL", "code_information": [{"code": "UBLADEFL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.09, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES SIZE 3 MCGRATH MAV VIDEO LARYNGOSCOPE 350-005-000", "code_information": [{"code": "350-005-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.86, "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": 202.7, "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": 294.5, "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": 237.62, "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": 24.65, "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": 27.6, "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": 54.38, "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": 24.3, "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": 36.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLASTOMYCES ANTIBODY", "code_information": [{"code": "86612", "type": "CPT"}], "standard_charges": [{"minimum": 11.61, "maximum": 584.01, "discounted_cash": 16.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 199.44, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 149.55, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 223.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 223.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 241.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 223.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 58.47, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 58.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPING SEROLOGIC RH PHNT", "code_information": [{"code": "86906", "type": "CPT"}], "standard_charges": [{"minimum": 6.98, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 21417.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 21417.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 11932.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLINK REFLEX TEST", "code_information": [{"code": "95933", "type": "CPT"}], "standard_charges": [{"minimum": 70.31, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 92.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLM GENE", "code_information": [{"code": "81209", "type": "CPT"}], "standard_charges": [{"minimum": 35.38, "maximum": 584.01, "discounted_cash": 51.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}], "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": 120.0, "maximum": 4936.0, "gross_charge": 675.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 234.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOC CLOT FACTOR V TEST", "code_information": [{"code": "85220", "type": "CPT"}], "standard_charges": [{"minimum": 15.89, "maximum": 584.01, "discounted_cash": 22.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 8.38, "maximum": 584.01, "discounted_cash": 26.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 6.67, "maximum": 584.01, "discounted_cash": 21.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD COMPONENT/PRODUCT NOC", "code_information": [{"code": "P9099", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "discounted_cash": 43.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD FUNGUS CULTURE", "code_information": [{"code": "87103", "type": "CPT"}], "standard_charges": [{"minimum": 16.61, "maximum": 584.01, "discounted_cash": 26.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 8.79, "maximum": 584.01, "discounted_cash": 12.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 52.26, "maximum": 584.01, "discounted_cash": 102.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PH", "code_information": [{"code": "82800", "type": "CPT"}], "standard_charges": [{"minimum": 3.75, "maximum": 584.01, "discounted_cash": 14.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT/IRRADIATION", "code_information": [{"code": "86945", "type": "CPT"}], "standard_charges": [{"minimum": 24.76, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRETATION", "code_information": [{"code": "85060", "type": "CPT"}], "standard_charges": [{"minimum": 22.73, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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[{"code": "P2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 7.23, "discounted_cash": 6.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 19.1, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 21.71, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATIENT SERUM", "code_information": [{"code": "86904", "type": "CPT"}], "standard_charges": [{"minimum": 14.71, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 95.0, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"discounted_cash": 185.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 339.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 339.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 366.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 339.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, FROZ/DEGLY/WASH", "code_information": [{"code": "P9054", "type": "HCPCS"}], "standard_charges": [{"minimum": 453.62, "maximum": 489.91, "discounted_cash": 324.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 453.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 453.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 489.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 453.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, IRRADIATED", "code_information": [{"code": "P9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.68, "maximum": 357.13, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 330.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 330.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 357.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 330.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY FLUID CELL COUNT", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY FLUID SPECIFIC GRAVITY", "code_information": [{"code": "84315", "type": "CPT"}], "standard_charges": [{"minimum": 2.95, "maximum": 584.01, "discounted_cash": 4.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLSTER RETENTION FOR SUT", "code_information": [{"code": "450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL DEEP", "code_information": [{"code": "20225", "type": "CPT"}], "standard_charges": [{"minimum": 484.34, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 484.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CORTICAL RING 8MM SMALL CASTLING LYO STERILE", "code_information": [{"code": "9404528", "type": "CDM"}], "standard_charges": [{"gross_charge": 1000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5828.68, "maximum": 33019.48, "discounted_cash": 11590.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21793.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21793.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33019.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28929.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19060.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16271.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5828.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3724.82, "maximum": 24388.83, "discounted_cash": 7422.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16096.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16096.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24388.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21367.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14078.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12018.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3724.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DRILL VCF-1006", "code_information": [{"code": "VCF-1006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT FEMORAL HEAD & NECK 27170", "code_information": [{"code": "27170", "type": "CPT"}, {"code": "1480202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1923.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 769.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 769.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1153.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1249.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1406.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING 3 PHASE", "code_information": [{"code": "78315", "type": "CPT"}], "standard_charges": [{"minimum": 336.66, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 369.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 369.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 399.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 369.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 369.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 336.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED AREA", "code_information": [{"code": "78300", "type": "CPT"}], "standard_charges": [{"minimum": 185.33, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 234.83, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 234.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 234.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 253.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 234.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 234.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}], "standard_charges": [{"minimum": 258.28, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 279.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 258.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 288.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION FOR BONE GRAFTING; SPINE SURGERY /SEPARATE INCISION 20939", "code_information": [{"code": "20939", "type": "CPT"}, {"code": "44897314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 79.43, "maximum": 4936.0, "gross_charge": 4737.0, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION ONLY 38220", "code_information": [{"code": "38220", "type": "CPT"}, {"code": "1643980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 223.74, "maximum": 4936.0, "gross_charge": 1151.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 460.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 690.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 748.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 230.14, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 213.96, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 213.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 242.27, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 253.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 253.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 273.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 253.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 253.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 242.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 173.1, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 176.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 176.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 176.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 176.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 184.48, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 251.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 184.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 92.01, "maximum": 584.01, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 117.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 108.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 19.97, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 26.31, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PATELLA WEDGE LYO 10MM", "code_information": [{"code": "6204601", "type": "CDM"}], "standard_charges": [{"gross_charge": 2024.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR CT/MRI IMAG", "code_information": [{"code": "55T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE WAX  LUKENS 901", "code_information": [{"code": "901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.14, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3525.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3354.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3342.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3115.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOOT STATIC AFO OTS  L4397", "code_information": [{"code": "L4397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 601.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOTIES YELLOW VASCULAR  DYNJSBY5H", "code_information": [{"code": "DYNJSBY5H", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.79, "setting": "both", "billing_class": "facility"}]}, {"description": "BORDETELLA ANTIBODY", "code_information": [{"code": "86615", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA ANTIBODY", "code_information": [{"code": "86619", "type": "CPT"}], "standard_charges": [{"minimum": 12.04, "maximum": 584.01, "discounted_cash": 17.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULISM IG IV", "code_information": [{"code": "90288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOVIE TIP 4 INCH COATED INSULATED", "code_information": [{"code": "E1455B4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1611.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOWL CEMENT MIXING SMARTMIX", "code_information": [{"code": "540176501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL GRADUATED MED 16OZ BSN STRL PROCEDURE PLASTIC LF STRL", "code_information": [{"code": "DYND50315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING CEMENT VACUUM SMARTMIX CTS", "code_information": [{"code": "5401-76-501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING PURPLE CEMENT TOWER SMARTMIX CTS", "code_information": [{"code": "5401-98-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL SET  125ML CELL SAVER", "code_information": [{"code": "261-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL UTILITY 32OZ GRADUATED STRL PROCEDURE PLASTIC LF STRL", "code_information": [{"code": "DYND50320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BPCI ADVANCED IN HOME VISIT", "code_information": [{"code": "G9987", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.24, "maximum": 67.24, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BPCI HOME VISIT", "code_information": [{"code": "G9187", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.24, "maximum": 67.24, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACE AFO MEDIUM RIGHT XL", "code_information": [{"code": "AFO", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1191.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE AFO SPRY STEP RIGHT SMALL", "code_information": [{"code": "L1951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 707.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE ANKLE FIT TO PT", "code_information": [{"code": "L1930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 727.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK LUMBAR SACRAL ORTHOSIS", "code_information": [{"code": "L0631", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3768.11, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK LUMBAR SACRAL ORTHOSIS RIGID POST FRAMES AND PANEL SPEEDY WRAP", "code_information": [{"code": "L0636", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK LUMBAR SACRAL ULTRALINE LSO", "code_information": [{"code": "LO631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6791.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK ONE SZ FITS MOST BLACK DME QUICKDRAW", "code_information": [{"code": "L0627", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1473.51, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK WHT LITE WITHOUT PANEL DONJOY QUICKDRAW", "code_information": [{"code": "L0626", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 707.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE CERVICAL DME", "code_information": [{"code": "L0200", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1677.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE DME", "code_information": [{"code": "L0484", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE DME BONE GRITH STIMULATOR", "code_information": [{"code": "E0748", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE DME LUMBAR SACRAL ORTHOSIS SUPPORT FLEXIBLE PREFABRICATED CORSETTINCLUDES", "code_information": [{"code": "L0628", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 262.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE KNEE ORTHOSIS 22 INCH LEFT", "code_information": [{"code": "L1830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE KNEE ORTHOSIS UNICENTRIC", "code_information": [{"code": "L1832", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2702.23, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LUMBAR EXTRA XL DME", "code_information": [{"code": "880HS-XXL", "type": "CDM"}], "standard_charges": [{"gross_charge": 234.71, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LUMBAR LG DME", "code_information": [{"code": "880HS-L", "type": "CDM"}], "standard_charges": [{"gross_charge": 234.71, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LUMBAR MED DME", "code_information": [{"code": "880HS-M", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 234.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LUMBAR XL DME", "code_information": [{"code": "880HS-XL", "type": "CDM"}], "standard_charges": [{"gross_charge": 234.71, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE SACRAL BLACK LUMBAR ULTRALIGN", "code_information": [{"code": "L0637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4996.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE TLSO TRIPLANAR 2 SHELLANT-STERNL", "code_information": [{"code": "L0460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3684.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE WRIST 8IN LG RIGHT BLACK V STRAP", "code_information": [{"code": "223255", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 215.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 244.43, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 264.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 244.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 410.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 180.02, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 180.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 180.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 194.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 180.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 180.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 303.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 138.16, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 138.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 138.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 149.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 138.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 138.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 584.01, "discounted_cash": 228.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 241.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 241.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 261.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 241.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 241.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5053.42, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5053.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5514.4, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5514.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4065.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1759.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN CANAL SHUNT PROCEDURE", "code_information": [{"code": "61070", "type": "CPT"}], "standard_charges": [{"minimum": 68.55, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1559.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 186.67, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 197.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 197.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 213.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 197.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 197.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 202.0, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 211.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 202.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 191.92, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 199.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 199.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 215.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 199.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 199.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 339.29, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 369.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 369.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 399.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 369.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 369.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 221.69, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1488.91, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1376.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1376.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1488.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1376.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1376.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 100.26, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 BRCA2 MRNA SEQ ALYS", "code_information": [{"code": "138U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 421.5, "discounted_cash": 608.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 584.01, "discounted_cash": 391.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 509.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 509.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81215", "type": "CPT"}], "standard_charges": [{"minimum": 125.87, "maximum": 584.01, "discounted_cash": 487.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 125.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 125.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 136.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 125.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 125.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 238.55, "maximum": 584.01, "discounted_cash": 572.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 238.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 238.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 257.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 238.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 238.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 525.81, "maximum": 852.98, "discounted_cash": 759.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 788.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 788.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 852.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 788.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 788.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 525.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 525.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FULL SEQ DUP/DEL", "code_information": [{"code": "81162", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3629.36, "discounted_cash": 2372.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3355.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3355.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3629.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3355.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3355.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1642.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1642.39, "methodology": 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"BCBS - PREFERRED", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL SEQ ALYS", "code_information": [{"code": "81216", "type": "CPT"}], "standard_charges": [{"minimum": 166.61, "maximum": 1752.0, "discounted_cash": 240.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.61, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 125.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST AUGMENTATION W/IMPLT", "code_information": [{"code": "19325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 10219.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "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": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11949.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10200.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9137.55, "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": 7947.64, "maximum": 16128.45, "discounted_cash": 17248.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10644.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10644.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16128.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14130.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9310.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7947.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8859.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 1260.55, "maximum": 1260.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECONSTRUCTION", "code_information": [{"code": "19350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1180.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST REDUCTION", "code_information": [{"code": "19318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1300.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 113.82, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 123.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 113.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 31.02, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 145.03, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 156.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 71.62, "maximum": 1270.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 140.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 959.88, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 888.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 888.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 959.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 888.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 124.05, "maximum": 584.01, "discounted_cash": 122.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 134.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 14.49, "maximum": 584.01, "discounted_cash": 14.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATHING CAPACITY TEST", "code_information": [{"code": "94010", "type": "CPT"}], "standard_charges": [{"minimum": 27.85, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF ALCOHOL MISUSE COUNSEL", "code_information": [{"code": "G0443", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.01, "maximum": 47.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.69, "maximum": 38.69, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.31, "maximum": 19.31, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}], "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": 2.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 6.39, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEFS SIZE MEDIUM  FITRIGHT ULTRA INCONTINENCE  FITULTRAMD", "code_information": [{"code": "FITULTRAMD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.5, "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": 21.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 411.66, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 176.04, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 175.74, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1789.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1848.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 233.42, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 233.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 245.92, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 245.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2116.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 51.57, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 408.2, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 106.07, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 253.49, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 97.75, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 242.28, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 242.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3363.01, "maximum": 6824.69, "discounted_cash": 8683.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4504.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4504.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6824.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5979.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3939.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3363.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4314.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2276.37, "maximum": 4619.53, "discounted_cash": 5990.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3048.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3048.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4619.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4047.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2666.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2276.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3108.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 266.6, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 266.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 271.85, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 271.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 239.98, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 299.46, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 299.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 92.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 306.86, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 511.82, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 433.26, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 299.09, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 299.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 93.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 545.13, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 545.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 116.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2070.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2507.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2333.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3145.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ LATSMS DRSI FLAP", "code_information": [{"code": "19361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1834.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUCELLA ANTIBODY", "code_information": [{"code": "86622", "type": "CPT"}], "standard_charges": [{"minimum": 8.04, "maximum": 584.01, "discounted_cash": 11.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUSH CLEANING 18IN X 2IN X 0.125 NYLON BRISTLES H", "code_information": [{"code": "BR-18-158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.79, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH FEMORAL CANUAL", "code_information": [{"code": "206-711-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH SCRUB NON STRL W/ PCMX DETERENT E Z SCRUB", "code_information": [{"code": "371163", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1664.44, "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": 10.57, "setting": "both", "billing_class": "facility"}]}, {"description": "BSS 30ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0035", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 584.01, "discounted_cash": 228.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 256.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BULB TIP YANKAUER WITHOUT VENT CND34870", "code_information": [{"code": "CND34870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BUN", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "633605", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.56, "maximum": 584.01, "gross_charge": 20.0, "discounted_cash": 5.14, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUNDLE OF HIS RECORDING", "code_information": [{"code": "93600", "type": "CPT"}], "standard_charges": [{"minimum": 138.08, "maximum": 3347.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 138.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 138.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 149.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 138.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% (SENSORCAINE) 10ML", "code_information": [{"code": "MED0036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% (SENSORCAINE) 30ML", "code_information": [{"code": "MED0037", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% 300 ML FOR PUMP", "code_information": [{"code": "MED0541", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.25% 50ML", "code_information": [{"code": "MED0258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% (SENSORCAINE) 10ML", "code_information": [{"code": "MED0041", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% 50ML VIAL", "code_information": [{"code": "MED0218", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.51, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% PF (SENSORCAINE) 30ML", "code_information": [{"code": "MED0042", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.41, "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": 8.11, "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": 7.63, "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": 8.11, "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": 15.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% (SENSORCAINE/EPI) 30ML", "code_information": [{"code": "MED0039", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.01, "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": 8.4, "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": 10.54, "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": 15.29, "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": 7.81, "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": 6.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR ORTHOPAEDIC TOOL 14MH40 LEGEND 14CM 4MM MATCH 14MH40", "code_information": [{"code": "14MH40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR VELYS NAV G1 FLUTED BALL 5MM 451611058", "code_information": [{"code": "451611058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ACORN 5MM 14 CM FLUTEDINSTR", "code_information": [{"code": "14AC50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ACORN 5MM 14CM", "code_information": [{"code": "MR8-14AC50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR BARREL 4.0MM 12FLUTE BLADE SHAVER FORMULA REPROCESS", "code_information": [{"code": "375-941-012R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARBIDE 3.2MM FLUTED SIDE CUTTER", "code_information": [{"code": "MHD-15C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 386.14, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CRANIOTOME LG 2.5MM X 25.4MM FLUTED ROUTER", "code_information": [{"code": "L-CRN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER 14 CM 6MM DRILL BIT ACORN FLUTED MIDAS REX LEGENDINSTR", "code_information": [{"code": "14AC60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.92, "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": 323.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER 5MM 10 CM BALL FLUTED LEGENDINSTR", "code_information": [{"code": "10BA50-MN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER 5MM 10 CM BALL FLUTED LEGENDINSTR MR8-10BA50F", "code_information": [{"code": "MR8-10BA50F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 337.74, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTING 1.85MM X 16MM FLUTED ROUTER", "code_information": [{"code": "A-CRN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.33, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTING 25.4MM WHEEL METAL CUTTER MIDAS REXINSTR", "code_information": [{"code": "MC254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTING 5MM FLUTED BALL", "code_information": [{"code": "QD8-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLNDR 5MM 14 CM FLUTED DRUMINSTR", "code_information": [{"code": "14CY50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLNDR 7.6MM 14 CM LNG DRUM FLUTEDINSTR", "code_information": [{"code": "14CY76L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CYLNDR 7.6MM LNG DRUM FLUTEDINSTR", "code_information": [{"code": "MR8-14CY76L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND 5MM 14 CM DRILL BIT BALL MIDAS REX LEGENDINSTR", "code_information": [{"code": "14BA50D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND 5MM 14CM DRILL BIT BALL", "code_information": [{"code": "MR8-14BA50D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND 5MM COARSE BALL LNG ATTCHMNT", "code_information": [{"code": "L-5DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DRUM 5MM FLUTED LNG ATTCHMNT", "code_information": [{"code": "L-5DRM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DRUM 7.6MM X 28.6MM FLUTED", "code_information": [{"code": "LHD-LS9-76", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 579.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG 4MM SHRT FLUTED REPROCESS", "code_information": [{"code": "5110015040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR LEGEND BA 3MM 12CM", "code_information": [{"code": "12BA30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR LEGEND BA 4MM 12CM", "code_information": [{"code": "12BA40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MATCHSTICK 3MM FLUTED LESS AGGRESSIVE LNG ATTCHMNT", "code_information": [{"code": "L-8NS-M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 333.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MH 3MM 12CM", "code_information": [{"code": "12MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ORTHO TOOL 14CM 4MM MR8-14MH40", "code_information": [{"code": "MR8-14MH40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR OVAL 4MM REPROCESS STERLINGINSTR", "code_information": [{"code": "H9101R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHAVER 3.5MM X 13CM BLUE SPHERICAL LG HUB REPROCESSINSTR", "code_information": [{"code": "H9110R", "type": "CDM"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHVR 4MM X 13CM ARTHROSCOPIC STR REPROCESS STONECUTTER LF STRLINSTR DISP", "code_information": [{"code": "7205330R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR STR 5.5MM BROWN SHAVER BLADE REPROCESS ARTHROSCOPIC ELITE ACROMIONIZER STRL", "code_information": [{"code": "72200725R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 15 CM MATCH HEAD FLUTEDINSTR", "code_information": [{"code": "15MH22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 23MM 8 CM TAPEREDINSTR", "code_information": [{"code": "F2/8TA23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 262.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 3MM LNG 10 CM MATCH HEAD SM BORE FLUTED LEGENDINSTR", "code_information": [{"code": "10MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.11, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 4MM MAUVE ACROMIONIZER ARTHROSCOPIC STRAIGHT REPROCESS STRLINSTR DISP", "code_information": [{"code": "7205326R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG 5MM LNG ATTCHMNT ACORN", "code_information": [{"code": "L-5AC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SURG PFJ MILLING", "code_information": [{"code": "-5927-050-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR TAPER 3MM MR8 MR8-F3/9TA30", "code_information": [{"code": "MR8-F3/9TA30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 672.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTORPHANOL (STADOL) INJ 1MG/ML 1 ML", "code_information": [{"code": "MED0049", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1069.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1215.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 635.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION US IMAG", "code_information": [{"code": "19083", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 730.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 480.79, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 480.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 472.21, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 472.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"minimum": 214.15, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 214.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"minimum": 67.76, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"minimum": 408.91, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "type": "CPT"}], "standard_charges": [{"minimum": 220.81, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 220.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3190.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3154.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2205.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN THRC", "code_information": [{"code": "63276", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2197.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL/IDRL LSN ANY LVL", "code_information": [{"code": "63290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", 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"standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-reactive protein; high sensitivity (hsCRP) 86141", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "41582017", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.66, "maximum": 584.01, "gross_charge": 9.75, "discounted_cash": 16.84, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;FLEXI SIGMOIDSCOPE", "code_information": [{"code": "G0104", "type": "HCPCS"}], "standard_charges": [{"minimum": 283.57, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;PELVIC/BREAST EXAM", "code_information": [{"code": "G0101", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.78, "maximum": 52.78, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 993.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3223.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2302.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2995.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2699.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 871.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 776.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 223.12, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 489.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 489.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3217.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3020.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2378.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3332.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2959.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2613.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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[{"code": "57465", "type": "CPT"}], "standard_charges": [{"minimum": 73.2, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE 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11.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROC", "code_information": [{"code": "95992", "type": "CPT"}], "standard_charges": [{"minimum": 56.25, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 83.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 83.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 89.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 83.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA AMP PROBE", "code_information": [{"code": "87481", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA DIR PROBE", "code_information": [{"code": "87480", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 50.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 50.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA SPECIES PNL AMP PRB", "code_information": [{"code": "68U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 208.24, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANISTER AMSORB PLUS PREFILLED G-CAN ABSORBER 1.4 L JLC2105489006", "code_information": [{"code": "JLC2105489006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [{"code": "80352", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS NATURAL", "code_information": [{"code": "80349", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 1-3", "code_information": [{"code": "80350", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": 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NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNUAL BLUNT TIP 3MM VESSEL", "code_information": [{"code": "30003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.99, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 10G CEMENT VCF-1007", "code_information": [{"code": "VCF-1007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA AC0012 150MM 20G 10MM CS AC0012", "code_information": [{"code": "AC0012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA ARTHROSCOPIC 8.5MM X 72MM GRN THRD REPROCESS POLYCARBONATE W/ DISPOSABLE", "code_information": [{"code": "72200903R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 161.13, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 12MM W/ RADIAL SLEEVE LONG VERSASTEP PLUS", "code_information": [{"code": "VS101512P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 5MM LONG RADIAL EXP SLV VS101505", "code_information": [{"code": "VS101505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DILATOR 5MM RADIALLY EXPAND VS101005", "code_information": [{"code": "VS101005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.09, "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": 6.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL 7FT TUBE CO2 SAMPLING LINE FEMALE LUER CONNECTOR W/ CARBON DIOXIDE", "code_information": [{"code": "1843", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL CO2 W/3IN SAMPLING LINE 3280RHET43U", "code_information": [{"code": "3280RHET43U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.15, "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": 16.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL NON FLARED OVER THE EAR FLEXIBLE W/ 7FT TUBING LF", "code_information": [{"code": "1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL O2 PEDIATRIC 7\" W/HEAD STRAP 1101", "code_information": [{"code": "1101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA REP 7MM X 7 CM PLASTIC W/ OBTURATOR", "code_information": [{"code": "AR-6550R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RF ACCURIAN 100MM 20G AC0009", "code_information": [{"code": "AC0009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 5.75MM X 7CM REPROCESS", "code_information": [{"code": "AR-6564R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.25MM X 7 CM REPROCESS TWISTIN STRL", "code_information": [{"code": "AR-6530R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.5MM GRAY THREADED REPROCESS W/ OBTURATOR", "code_information": [{"code": "214118R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SURG 8.5MM X 75MM CLR THREADED REPROCESS", "code_information": [{"code": "214120R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA UNIVERSAL 11MM STD FIX UNVCA11STF", "code_information": [{"code": "UNVCA11STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULAINSTR 7MM X 7CM CLR REPROCESS REPROCESS WITHOUT SQUIRT CAP TWISTIN", "code_information": [{"code": "AR-6570R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP ADULT HEAD POSITIONER", "code_information": [{"code": "NON081148NC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP DME BRACE LUMBAR ORTHOSIS, EXTENDS FROM L-1 TO BELOW L-5", "code_information": [{"code": "L0642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP LUER LOCK TIP TAMPER EVIDENT RED", "code_information": [{"code": "H93864010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP PROTECTION 6IN X 16IN LUER LOCK TIP TAMPER EVIDENT", "code_information": [{"code": "H93864110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP REDUCER ENDO ONE SEAL ENDOPATH STRL", "code_information": [{"code": "1SEAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP REPLACE FEMALE MALE FOR PROTECTED NDL", "code_information": [{"code": "654496", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 0.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP REPLACEMENT BMG474900", "code_information": [{"code": "BMG474900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR N-INVAS LOC", "code_information": [{"code": "745T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARRHYT DLVR RAD", "code_information": [{"code": "747T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 526.41, "discounted_cash": 760.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 526.41, "maximum": 1171.4, "discounted_cash": 760.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1171.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 526.41, "maximum": 1171.4, "discounted_cash": 760.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1171.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 36.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CARCINOEMBRYONIC ANTIGEN", "code_information": [{"code": "82378", "type": "CPT"}], "standard_charges": [{"minimum": 17.06, "maximum": 584.01, "discounted_cash": 24.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51970.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34241.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 29229.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 20496.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 114.94, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"minimum": 213.95, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 213.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.28, "maximum": 14.28, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN ANTIBODY EA IG", "code_information": [{"code": "86147", "type": "CPT"}], "standard_charges": [{"minimum": 22.91, "maximum": 584.01, "discounted_cash": 33.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2916.0, "discounted_cash": 4212.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 872.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 806.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}], "standard_charges": [{"minimum": 127.75, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 169.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 169.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 169.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 98.81, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 152.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 98.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93016", "type": "CPT"}], "standard_charges": [{"minimum": 28.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93017", "type": "CPT"}], "standard_charges": [{"minimum": 50.86, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93018", "type": "CPT"}], "standard_charges": [{"minimum": 19.05, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC EXT", "code_information": [{"code": "92960", "type": "CPT"}], "standard_charges": [{"minimum": 208.57, "maximum": 2133.0, "discounted_cash": 826.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 413.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 208.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC INT", "code_information": [{"code": "92961", "type": "CPT"}], "standard_charges": [{"minimum": 283.37, "maximum": 2133.0, "discounted_cash": 826.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 466.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 466.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 504.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 466.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 340.18, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 340.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.47, "maximum": 68.47, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.54, "maximum": 111.54, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 45 M", "code_information": [{"code": "G0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 175.91, "maximum": 175.91, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 249.12, "maximum": 249.12, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 75 M", "code_information": [{"code": "G0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 298.02, "maximum": 298.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 30 M", "code_information": [{"code": "G0086", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.45, "maximum": 100.45, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.67, "maximum": 140.67, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.51, "maximum": 68.51, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.05, "maximum": 103.05, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 103.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.55, "maximum": 166.55, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.48, "maximum": 226.48, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"minimum": 298.02, "maximum": 298.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAGE BEH SVS 20MINS", "code_information": [{"code": "G0323", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.09, "maximum": 79.09, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 78.3, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 78.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE OF MISCARRIAGE", "code_information": [{"code": "59820", "type": "CPT"}], "standard_charges": [{"minimum": 559.9, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 4.38, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING 1ST 30 MIN", "code_information": [{"code": "97550", "type": "CPT"}], "standard_charges": [{"minimum": 73.38, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING EA ADDL 15", "code_information": [{"code": "97551", "type": "CPT"}], "standard_charges": [{"minimum": 36.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREPATCH PER SQ CM", "code_information": [{"code": "Q4236", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [{"code": "35", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10152.43, "maximum": 26147.99, "discounted_cash": 21374.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17257.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17257.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26147.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22909.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15094.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12884.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10152.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [{"code": "34", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17254.6, "maximum": 35015.41, "discounted_cash": 34609.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23110.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23110.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35015.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30678.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20213.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17254.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17355.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8181.13, "maximum": 23368.84, "discounted_cash": 17371.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15423.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15423.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23368.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20474.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13489.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11515.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8181.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID INTIMA ATHEROMA EVAL", "code_information": [{"code": "93895", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO +30MIN", "code_information": [{"code": "94781", "type": "CPT"}], "standard_charges": [{"minimum": 29.46, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 73.8, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 103.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTILAGE GRAFT COSTOCHONDRAL 20910", "code_information": [{"code": "20910", "type": "CPT"}, {"code": "17290374", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 924.07, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 611.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTRIDGE TEST DRUG ISTAT E3 PLUS", "code_information": [{"code": "3P8225", "type": "CDM"}], "standard_charges": [{"gross_charge": 21.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE TESTING PROTHROMBIN TIME LABORATORY ISTAT", "code_information": [{"code": "3P8924", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE STRL FIVE CYCLE HYDROGEN PEROXIDE STERRAD NX", "code_information": [{"code": "10113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST PADDING WEBRIL 3 INCH NC", "code_information": [{"code": "MDS066003Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CAT SCAN FOLLOW-UP STUDY", "code_information": [{"code": "76380", "type": "CPT"}], "standard_charges": [{"minimum": 114.97, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 125.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 125.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 135.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 125.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 125.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATARACT SURG W/IOL 1 STAGE", "code_information": [{"code": "66983", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1628.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH FOLEY 12FR 2W 5CC (REPL 0165SI12)", "code_information": [{"code": "175812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.89, "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": 22.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY LF SILICON 16FR 10ML DYND11502", "code_information": [{"code": "DYND11502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.19, "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": 19.28, "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": 8.93, "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": 8.62, "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": 8.94, "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": 8.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"minimum": 182.53, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 328.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 182.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER BALLOON  KIT ARCADIA  ARC20SB-LK", "code_information": [{"code": "ARC20SB-LK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13029.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CATHENA SAFETY IV PINK 20 G X 2' 386864", "code_information": [{"code": "386864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CLEARPRO CLOSED SUCTION 14", "code_information": [{"code": "DYNCPDS14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESPH PYL 7.5FR 15-18MM 180CM 5.5CM WG BLNDIL CRE", "code_information": [{"code": "M00558430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FEMALE EXTERNA B-DPWFX30", "code_information": [{"code": "B-DPWFX30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.94, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FLEY SILICONE 10FR 3ML", "code_information": [{"code": "165810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 100% SILICNE 12FR 5ML 165812", "code_information": [{"code": "165812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 100%SILICONE 20FR 10ML LF", "code_information": [{"code": "DYND11504H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 12 FRENCH 10 ML COUDE STRL", "code_information": [{"code": "102L12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 12FR 5ML SIL-ELASTOMER 0165V12S", "code_information": [{"code": "165V12S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 14FR 10 ML UNCOATED SILICONE", "code_information": [{"code": "165814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 14FR 5ML 2 WAY COUDE IC BARDEX", "code_information": [{"code": "102SI14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16 FRENCH 5 ML RED COUNCIL 2 WAY", "code_information": [{"code": "196L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 10ML COUDE 2 WAY STANDARD SPECIALTY", "code_information": [{"code": "102L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5 ML URETHRAL TWO WAY SILICONE HYDROGEL LUBRISIL STERILE", "code_information": [{"code": "175816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5ML 2 WAY COUDE ICINFECTION CONTROL BARDEX", "code_information": [{"code": "102SI16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5MM ELASTOMER SILICONE", "code_information": [{"code": "165V16S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 10ML COUDE 2 WAY STANDARD SPECIALTY", "code_information": [{"code": "102L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.99, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 5 ML URETHRAL TWO WAY SILICONE HYDROGEL LUBRISIL STERILE", "code_information": [{"code": "175818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML 2 WAY COUNCIL TIP", "code_information": [{"code": "196L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 20FR 5 ML URETHRAL TWO WAY ALL SILICONE HYDROGEL LUBRISIL", "code_information": [{"code": "175820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 22FR 30CC THREE WAY UROLOGIC", "code_information": [{"code": "167L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 5CC 14 FRENCH RED", "code_information": [{"code": "102L14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.99, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 8FR 3CC 2 WAY BLLN SILICONE STRL PEDI DISP", "code_information": [{"code": "165PL08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.13, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 18FR 5CC 2-WAY 0168L18", "code_information": [{"code": "168L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 18FR 5ML 2-WAY 0168SI18", "code_information": [{"code": "168SI18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY SAFE SECURE STRL", "code_information": [{"code": "UROSECURE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 760.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY SILICONE3-WAY 20 FR 30 ML  DYND11574", "code_information": [{"code": "DYND11574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}], "standard_charges": [{"minimum": 312.11, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER INTEGRA HERMETIC LUMBAR CLOSED TIP", "code_information": [{"code": "INS-5010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1183.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER INTRAVENOUS INTROCAN FEP TEFLON SAFETY 20GA 25.4MM STRAIGHT HUB", "code_information": [{"code": "425254302A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 336.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA 1.25IN RADPQ SFSHLD", "code_information": [{"code": "425253502A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1IN RADIOPAQUE JELCO", "code_information": [{"code": "405720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV ANGIOCATH PTFE 12G 3 382277", "code_information": [{"code": "382277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.51, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SAFETY 14G X2 FEP STRGHT 4252594-02", "code_information": [{"code": "4252594-02", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SAFETY 22G X1 FEP STRGHT 4252519-02", "code_information": [{"code": "4252519-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER KIT CENTRAL VENOUS 7FR 16CM ARW42703XP1A", "code_information": [{"code": "ARW42703XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 2-WAY 16FR 30CC SILICONE DISP", "code_information": [{"code": "176816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 22FR 30CC SILICONE DISP", "code_information": [{"code": "73022L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 24FR 30CC SILICONE DISP", "code_information": [{"code": "73024L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MELKER EMERGENCY CRICITHYROTOMY SET 6MM X 7.5CM", "code_information": [{"code": "C-TCCS-600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 632.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MULTI LMN 7FR 16CM CDC-42703-XP1A", "code_information": [{"code": "CDC-42703-XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PUREWICK FEMALE EXTERNAL PWFX30", "code_information": [{"code": "PWFX30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SAFETY IV  INTROCAN 16G X 2 BMG4252578", "code_information": [{"code": "BMG4252578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SHORT / SIDE OFFSET 7601-735105", "code_information": [{"code": "7601-735105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2021.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SNAPSECURE 1-LAYER FOLEY  TRAY 100% SILICONE 16 FR 10 ML URO175716", "code_information": [{"code": "URO175716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER STEERABLE BALLOON ARC25SB", "code_information": [{"code": "ARC25SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 10FR WITHOUT CONTROL VALVE STRL", "code_information": [{"code": "33000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 12FR SILICONE", "code_information": [{"code": "DYND11500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 14FR 20IN COILED WITHOUT CONTROL PORT STRL ST", "code_information": [{"code": "T60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION 8FR 12IN RADIOPAQUE URETHRAL ROUND RED RUBBER", "code_information": [{"code": "8887660085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SUCTION CONTROL PORT 18 FR T62C", "code_information": [{"code": "T62C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.41, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SYSTEM SAF-T-INTIMA 20GA X 1 383336", "code_information": [{"code": "383336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER TRAYS ADVANCE I. C. FOLEY BRD942216", "code_information": [{"code": "BRD942216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 14FR 10 ML 2 WAY FOLEY SILICONE LF", "code_information": [{"code": "DYND11501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 14FR RED GENERAL PURP", "code_information": [{"code": "277714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 16FR 5CC SHRT ROUND TIP 2 OPPOSING EYE LUBRICATED FOLEY THREE", "code_information": [{"code": "119L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 16FR RED GENERAL PURP", "code_information": [{"code": "277716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 18 FRENCH COUDE TIEMANN", "code_information": [{"code": "15090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETHRAL 18FR RED ALL PURP", "code_information": [{"code": "277718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URINARY LG 35MM EXTERNAL EXO DOUBLE SIDE ADHESIVE TAPE MALE", "code_information": [{"code": "DYND12301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URINARY MD 30MM EXTERNAL EXO DOUBLE SIDE ADHESIVE TAPE MALE", "code_information": [{"code": "DYND12302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URINARY SM 25MM EXTERNAL LATEX DOUBLE SIDED ADHESIVE TAPE MALE", "code_information": [{"code": "DYND12303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER VENOUS 18GA X 1 1/4IN GRN PERIPH ANGIOCATH STRAIGHT UNIVERSAL BEVELINTR", "code_information": [{"code": "4252560-02", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER VENOUS 18GA X 1 1/4IN GRN PERIPH SAFETY NDL WINGED UNIVERSAL BEVEL FEP", "code_information": [{"code": "4254562-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.62, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETERIZE FOR URINE SPEC", "code_information": [{"code": "P9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.7, "maximum": 1100.0, "discounted_cash": 12.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION OF CERVIX", "code_information": [{"code": "57510", "type": "CPT"}], "standard_charges": [{"minimum": 216.55, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 4241.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4241.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6426.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5630.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3709.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3166.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3931.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEMENT GUN 90 DEGREE EASY N JECT VCF-KVTGUN-DS1", "code_information": [{"code": "VCF-KVTGUN-DS1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1292.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"minimum": 120.72, "maximum": 120.72, "discounted_cash": 174.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 120.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 120.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 7.23, "discounted_cash": 6.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEREBROSPINAL FLUID SCAN", "code_information": [{"code": "78630", "type": "CPT"}], "standard_charges": [{"minimum": 345.23, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 376.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 376.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 407.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 376.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 376.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12930.2, "maximum": 50689.61, "discounted_cash": 26342.15, "estimated_discounted_cash": 63151.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 9821.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9821.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14881.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13038.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8590.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7333.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3691.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3691.0, "maximum": 21401.82, "discounted_cash": 14748.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14125.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14125.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21401.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18750.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12354.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10546.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3691.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2634.0, "maximum": 12398.14, "discounted_cash": 8572.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8182.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8182.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12398.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10862.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7156.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6109.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2634.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"minimum": 142.77, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CETACAINE SPRAY 5 GM", "code_information": [{"code": "MED0056", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 186.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CFTR GENE COM VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}], "standard_charges": [{"minimum": 500.94, "maximum": 1752.0, "discounted_cash": 723.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 584.01, "discounted_cash": 565.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE FULL SEQUENCE", "code_information": [{"code": "81223", "type": "CPT"}], "standard_charges": [{"minimum": 449.1, "maximum": 1752.0, "discounted_cash": 648.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 151.88, "maximum": 584.01, "discounted_cash": 219.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 343.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 87.5, "maximum": 584.01, "discounted_cash": 126.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1008.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE NEPHROURETERAL CATH", "code_information": [{"code": "50387", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51705", "type": "CPT"}], "standard_charges": [{"minimum": 134.37, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 187.5, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 96.05, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 41.17, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 41.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1315.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1256.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 129.15, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 319.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 319.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 345.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 319.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 319.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 467.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEM CAUT OF GRANLTJ TISSUE", "code_information": [{"code": "17250", "type": "CPT"}], "standard_charges": [{"minimum": 119.11, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 699.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 504.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 435.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASSAY", "code_information": [{"code": "82397", "type": "CPT"}], "standard_charges": [{"minimum": 12.71, "maximum": 584.01, "discounted_cash": 18.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ANTI-NEOPL SQ/IM", "code_information": [{"code": "96401", "type": "CPT"}], "standard_charges": [{"minimum": 94.77, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO BY BOTH INFUSION AND O", "code_information": [{"code": "Q0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO BY OTHER THAN INFUSION", "code_information": [{"code": "Q0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO EXTEND IV INFUS W/PUMP", "code_information": [{"code": "G0498", "type": "HCPCS"}], "standard_charges": [{"minimum": 470.4, "maximum": 508.03, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 508.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO HORMON ANTINEOPL SQ/IM", "code_information": [{"code": "96402", "type": "CPT"}], "standard_charges": [{"minimum": 51.26, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 58.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 58.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 99.24, "maximum": 584.01, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 150.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 183.81, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 300.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 300.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 324.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 300.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA PUSH TECNIQUE", "code_information": [{"code": "96420", "type": "CPT"}], "standard_charges": [{"minimum": 137.58, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 186.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 186.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 201.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 186.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 175.36, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 208.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 208.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 225.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 208.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 112.5, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 149.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 149.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 160.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 149.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 87.5, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 121.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION 1 HR", "code_information": [{"code": "96413", "type": "CPT"}], "standard_charges": [{"minimum": 174.66, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 259.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 174.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION ADDL HR", "code_information": [{"code": "96415", "type": "CPT"}], "standard_charges": [{"minimum": 37.69, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 75.2, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 137.02, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 211.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 174.35, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 249.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 249.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 269.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 249.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 174.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 211.84, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 383.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 355.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 211.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 132.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 169.74, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 250.58, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 250.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREMITY 1-4", "code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 214.17, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 214.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 114.41, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 134.7, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 202.56, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 202.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 186.26, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 1-5", "code_information": [{"code": "64646", "type": "CPT"}], "standard_charges": [{"minimum": 222.4, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 248.31, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 452.93, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 452.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 14.39, "maximum": 584.01, "discounted_cash": 20.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.72, "maximum": 197.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 182.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 197.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 182.72, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 227.32, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 322.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 322.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 348.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 322.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INJECTION", "code_information": [{"code": "96542", "type": "CPT"}], "standard_charges": [{"minimum": 178.22, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 217.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 217.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 234.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 217.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INTO CNS", "code_information": [{"code": "96450", "type": "CPT"}], "standard_charges": [{"minimum": 215.22, "maximum": 584.01, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 361.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [{"code": "837", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22347.13, "maximum": 92474.65, "discounted_cash": 42956.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61033.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61033.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92474.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81020.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53382.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 45568.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22347.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [{"code": "838", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9051.86, "maximum": 24139.68, "discounted_cash": 18664.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15932.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15932.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24139.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21149.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13934.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11895.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9051.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5020.78, "maximum": 10188.85, "discounted_cash": 12910.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6724.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6724.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10188.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8926.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5881.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5020.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6116.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5671.13, "maximum": 13904.03, "discounted_cash": 11697.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 102.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 110.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 102.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORD BOVIE MONOPOLAR", "code_information": [{"code": "E0510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CHORION BIOPSY", "code_information": [{"code": "59015", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 207.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORNC GONADOTROPIN HCG IA", "code_information": [{"code": "167U", "type": "CPT"}], "standard_charges": [{"minimum": 6.77, "maximum": 10.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99491", "type": "CPT"}], "standard_charges": [{"minimum": 121.86, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99437", "type": "CPT"}], "standard_charges": [{"minimum": 85.87, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 85.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAF EA ADDL", "code_information": [{"code": "99439", "type": "CPT"}], "standard_charges": [{"minimum": 68.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAFF 1ST 20", "code_information": [{"code": "99490", "type": "CPT"}], "standard_charges": [{"minimum": 89.82, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMATOGRAM ASSAY SUGARS", "code_information": [{"code": "84375", "type": "CPT"}], "standard_charges": [{"minimum": 10.62, "maximum": 584.01, "discounted_cash": 50.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOGENIC SUBSTRATE ASSAY", "code_information": [{"code": "85130", "type": "CPT"}], "standard_charges": [{"minimum": 10.7, "maximum": 584.01, "discounted_cash": 15.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS AMNIOTIC", "code_information": [{"code": "88269", "type": "CPT"}], "standard_charges": [{"minimum": 156.29, "maximum": 584.01, "discounted_cash": 225.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 306.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 306.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 331.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 306.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 306.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 156.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 156.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS PLACENTA", "code_information": [{"code": "88267", "type": "CPT"}], "standard_charges": [{"minimum": 169.71, "maximum": 584.01, "discounted_cash": 245.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 169.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 169.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 100", "code_information": [{"code": "88249", "type": "CPT"}], "standard_charges": [{"minimum": 155.85, "maximum": 584.01, "discounted_cash": 225.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 344.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 15-20", "code_information": [{"code": "88262", "type": "CPT"}], "standard_charges": [{"minimum": 112.94, "maximum": 584.01, "discounted_cash": 163.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 248.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88245", "type": "CPT"}], "standard_charges": [{"minimum": 155.85, "maximum": 584.01, "discounted_cash": 225.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 274.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 274.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 296.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 274.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 274.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88264", "type": "CPT"}], "standard_charges": [{"minimum": 130.15, "maximum": 584.01, "discounted_cash": 187.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 248.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 45", "code_information": [{"code": "88263", "type": "CPT"}], "standard_charges": [{"minimum": 135.26, "maximum": 584.01, "discounted_cash": 195.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 276.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 276.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 299.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 276.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 276.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 5", "code_information": [{"code": "88261", "type": "CPT"}], "standard_charges": [{"minimum": 237.91, "maximum": 584.01, "discounted_cash": 343.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 352.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 237.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 237.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 50-100", "code_information": [{"code": "88248", "type": "CPT"}], "standard_charges": [{"minimum": 155.85, "maximum": 584.01, "discounted_cash": 225.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 344.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 318.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME BANDING STUDY", "code_information": [{"code": "88283", "type": "CPT"}], "standard_charges": [{"minimum": 61.74, "maximum": 584.01, "discounted_cash": 89.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 61.74, "methodology": "fee schedule"}, {"payer_name": "UNITED 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EX", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME KARYOTYPE STUDY", "code_information": [{"code": "88280", "type": "CPT"}], "standard_charges": [{"minimum": 30.12, "maximum": 584.01, "discounted_cash": 43.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 46.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME STUDY ADDITIONAL", "code_information": [{"code": "88289", "type": "CPT"}], "standard_charges": [{"minimum": 30.99, "maximum": 584.01, "discounted_cash": 44.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 62.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "BCBS - SELECT", "standard_charge_dollar": 7828.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5157.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4402.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3834.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [{"code": "190", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5011.95, "maximum": 12542.67, "discounted_cash": 9904.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8278.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8278.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12542.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10989.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7240.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6180.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5011.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2888.45, "maximum": 6649.87, "discounted_cash": 5740.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4388.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4388.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6649.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5826.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3838.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3276.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2888.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT 30 MINS", "code_information": [{"code": "G3002", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.16, "maximum": 117.16, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT ADDL 15M", "code_information": [{"code": "G3003", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.89, "maximum": 42.89, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 42.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CILIARY TRANSSLERAL THERAPY", "code_information": [{"code": "66710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR 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"standard_charge_dollar": 97.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS ADD-ON", "code_information": [{"code": "76125", "type": "CPT"}], "standard_charges": [{"minimum": 38.61, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, 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989805609611", "code_information": [{"code": "9.90E+11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 70IN UNIVERSAL ANESTHESIA SNGL LIMB SNGL LIMB W/ FILTER AND BA", "code_information": [{"code": "DF370-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.06, "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": 34.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 72IN ANESTHESIA SAMPLE LINE 6 MASK SNGL LIMB KING FLEX2", "code_information": [{"code": "DF376-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3133.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BRTHG PORT LN BG MSK 60IN ADLT 3L NS LF UNV F2 LG", "code_information": [{"code": "D366-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.47, "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": 60.03, "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": 9877.96, "maximum": 31001.53, "discounted_cash": 19785.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20461.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20461.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31001.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27161.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17895.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15276.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9877.96, "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": 4863.33, "maximum": 17348.03, "discounted_cash": 9568.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11449.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11449.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17348.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15199.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10014.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8548.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4863.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUM 28 DAYS OR OLDER", "code_information": [{"code": "54161", "type": "CPT"}], "standard_charges": [{"minimum": 243.97, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 243.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"minimum": 304.38, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "type": "CPT"}], "standard_charges": [{"minimum": 203.02, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 203.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUT CONNECYOR 1/4 X 3/8 REDUCER  XA6051", "code_information": [{"code": "XA6051", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4603.62, "maximum": 9342.31, "discounted_cash": 9443.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6165.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6165.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9342.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8185.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5392.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4603.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4774.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7406.36, "maximum": 15030.0, "discounted_cash": 17598.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9919.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9919.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15030.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13168.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8676.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7406.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8743.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3095.76, "maximum": 6282.35, "discounted_cash": 6370.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4146.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4146.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6282.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5504.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3626.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3095.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3108.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CKMB", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "1221822", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.4, "maximum": 584.01, "gross_charge": 20.0, "discounted_cash": 15.02, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2555.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAMP GRASPING 10MM X 31CM ENDO BABCOCK 34 X 44MM JAW 360DEG ROTATATION", "code_information": [{"code": "174001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 788.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1712.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAMP SURG 12MM MUSCLE PENCIL POINT RAYPORT STRL DISP", "code_information": [{"code": "SU130-1112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAVE CONNECTOR C1000", "code_information": [{"code": "C1000", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69220", "type": "CPT"}], "standard_charges": [{"minimum": 104.29, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 104.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69222", "type": "CPT"}], "standard_charges": [{"minimum": 286.55, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEANER ANTI FOG 6ML BTL FOAM PAD", "code_information": [{"code": "600-AF031-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER ANTI FOG NON IRRITATING W/ FOAM PAD MR CLR LF STRL BT DISP", "code_information": [{"code": "AF031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER PIPE LATEX FREE", "code_information": [{"code": "25-1904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANER TIP ELECTROSURGICAL PENCIL LECTROBRASIVE LF STRL DISP", "code_information": [{"code": "E2401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANING BRUSHES LARGE DIAMETER ASSORTMENT 1 PKG EACH OF 9 BR-4399", "code_information": [{"code": "BR-4399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANING BRUSHES MOST POPULAR ASSORTMENT 1 PKG EACH OF 9 DIFFERENT BR-4499", "code_information": [{"code": "BR-4499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANSER WND 20 ML GENERAL PURP POUR BOTTLE FOR USE ON ACUTE NON SURG TRAUMATIC", "code_information": [{"code": "121222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69200", "type": "CPT"}], "standard_charges": [{"minimum": 108.58, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 108.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69205", "type": "CPT"}], "standard_charges": [{"minimum": 116.83, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 62.44, "maximum": 4936.0, "discounted_cash": 273.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 97.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF TEAR DUCT", "code_information": [{"code": "68530", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 579.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINCH ENDOSCOPIC II 5MM 174317", "code_information": [{"code": "174317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 763.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/50ML D5W IV SOL", "code_information": [{"code": "MED0580", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN PHOS 900 MG VIAL 50 ML", "code_information": [{"code": "228546", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN/CLEOCIN 2% VAG CREAM 40GM", "code_information": [{"code": "MED0063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 209.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP APPLIER LIGACLIP ENDO ROTATNG S ER420", "code_information": [{"code": "ER420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ENDO LG 10MM PISTOL GRIP APPLIE 176625", "code_information": [{"code": "176625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 686.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMO + TITANIUM SML EZ LOAD NO TAPE", "code_information": [{"code": "533837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.66, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING HEMOCLIP PLUS YELLOW SM TI STRL", "code_information": [{"code": "5-33837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM PILLING TANTALUM", "code_information": [{"code": "W523100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.63, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SMALL-WIDE WECK HORIZON TIT PLW1201", "code_information": [{"code": "PLW1201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING TITANIUM MEDIUM 002200", "code_information": [{"code": "2200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.35, "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": 253.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPPER BLADE UNIVERSAL", "code_information": [{"code": "SMBLADEU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.91, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS EXTRA LIGATING TITANUM LIGACLIP SM LT100", "code_information": [{"code": "LT100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS LIGATING TITANIUM MED/LARGE 003200", "code_information": [{"code": "3200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.1 MG TABLET", "code_information": [{"code": "MED0502", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.19, "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": 22.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 935.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3438.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1143.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1428.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 798.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2400.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2462.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1797.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1920.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 292.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 193.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION POST HIP ARTHROPLASTY W/ ANESTHESIA 27266", "code_information": [{"code": "27266", "type": "CPT"}, {"code": "1480318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 735.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION SHOULDER DISLOCATION W/ANESTHESIA 23655", "code_information": [{"code": "23655", "type": "CPT"}, {"code": "1480325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 551.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1063.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/MANIPULJ", "code_information": [{"code": "21401", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [{"code": "21400", "type": "CPT"}], "standard_charges": [{"minimum": 314.51, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 314.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [{"code": "21337", "type": "CPT"}], "standard_charges": [{"minimum": 564.63, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 564.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/MANJ", "code_information": [{"code": "22315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1315.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 448.19, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 584.01, "discounted_cash": 20.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE DEVICE V-LOC 90 3-0 VLOCM0134", "code_information": [{"code": "VLOCM0134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"minimum": 240.67, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 716.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VAGINA", "code_information": [{"code": "57120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 632.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2127.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2067.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE SKIN PRINEO DERMABOND 22CM CLR222US", "code_information": [{"code": "CLR222US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1333.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1074.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE WOUND DEHISCENCE-SUPERFICIAL 12020", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "1480358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 924.07, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 418.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURES:DERMABOND PRINEO SKIN CLOSURE SYSTEM 60CM CLR602US", "code_information": [{"code": "CLR602US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.02, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOT FACTOR FLETCHER FACT", "code_information": [{"code": "85292", "type": "CPT"}], "standard_charges": [{"minimum": 17.04, "maximum": 584.01, "discounted_cash": 24.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR II PROTHROM SPEC", "code_information": [{"code": "85210", "type": "CPT"}], "standard_charges": [{"minimum": 11.68, "maximum": 584.01, "discounted_cash": 16.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR IX PTC/CHRSTMAS", "code_information": [{"code": "85250", "type": "CPT"}], "standard_charges": [{"minimum": 17.14, "maximum": 584.01, "discounted_cash": 24.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 35.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII PROCONVERTIN", "code_information": [{"code": "85230", "type": "CPT"}], "standard_charges": [{"minimum": 16.11, "maximum": 584.01, "discounted_cash": 23.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII AHG 1 STAGE", "code_information": [{"code": "85240", "type": "CPT"}], "standard_charges": [{"minimum": 16.11, "maximum": 584.01, "discounted_cash": 23.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII MULTIMETRIC", "code_information": [{"code": "85247", "type": "CPT"}], "standard_charges": [{"minimum": 20.65, "maximum": 584.01, "discounted_cash": 29.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII RELTD ANTGN", "code_information": [{"code": "85244", "type": "CPT"}], "standard_charges": [{"minimum": 18.38, "maximum": 584.01, "discounted_cash": 26.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.6, "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 - BLUE NETWORK E", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.65, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XI PTA", "code_information": [{"code": "85270", "type": "CPT"}], "standard_charges": [{"minimum": 16.11, "maximum": 584.01, "discounted_cash": 23.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XII HAGEMAN", "code_information": [{"code": "85280", "type": "CPT"}], "standard_charges": [{"minimum": 17.42, "maximum": 584.01, "discounted_cash": 25.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 35.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}], 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.45, "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": 9.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOTTING ASSAY WHOLE BLOOD", "code_information": [{"code": "85396", "type": "CPT"}], "standard_charges": [{"minimum": 18.84, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 210.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX W/MNPJ&STABLJ", "code_information": [{"code": "21320", "type": "CPT"}], "standard_charges": [{"minimum": 292.06, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 292.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 163.15, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 375.14, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC WO MNPJ", "code_information": [{"code": "23540", "type": "CPT"}], "standard_charges": [{"minimum": 363.82, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 537.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [{"code": "23500", "type": "CPT"}], "standard_charges": [{"minimum": 339.79, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX W/MNPJ", "code_information": [{"code": "23625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 407.81, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 407.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 773.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 497.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 497.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 424.71, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 424.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 582.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 501.46, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 703.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 603.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 350.59, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 350.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 827.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 655.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ WO ANES", "code_information": [{"code": "23650", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 569.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 586.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 355.99, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 568.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 680.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLYDESDALE PTC 22MM  12 DEG  12MM X 45MM 4922245", "code_information": [{"code": "4922245", "type": "CDM"}], "standard_charges": [{"gross_charge": 10000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CMBN ANT PST COLPRHY", "code_information": [{"code": "57260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1026.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH 10-20MIN", "code_information": [{"code": "G9869", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.54, "maximum": 51.54, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH <10MIN", "code_information": [{"code": "G9868", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.53, "maximum": 38.53, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH >20MIN", "code_information": [{"code": "G9870", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.54, "maximum": 64.54, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI MOD HOME VISIT", "code_information": [{"code": "G9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.24, "maximum": 67.24, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 1.1-2.5 CM", "code_information": [{"code": "13151", "type": "CPT"}], "standard_charges": [{"minimum": 559.03, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 2.6-7.5 CM", "code_information": [{"code": "13152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 654.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [{"code": "13153", "type": "CPT"}], "standard_charges": [{"minimum": 251.51, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13131", "type": "CPT"}], "standard_charges": [{"minimum": 512.17, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13132", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13133", "type": "CPT"}], "standard_charges": [{"minimum": 224.76, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [{"code": "13120", "type": "CPT"}], "standard_charges": [{"minimum": 467.14, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 467.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 2.6-7.5 CM", "code_information": [{"code": "13121", "type": "CPT"}], "standard_charges": [{"minimum": 556.91, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 556.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L ADDL 5 CM/>", "code_information": [{"code": "13122", "type": "CPT"}], "standard_charges": [{"minimum": 170.49, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 1.1-2.5 CM", "code_information": [{"code": "13100", "type": "CPT"}], "standard_charges": [{"minimum": 449.46, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 449.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK ADDL 5CM/<", "code_information": [{"code": "13102", "type": "CPT"}], "standard_charges": [{"minimum": 159.33, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"minimum": 18.65, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"minimum": 19.08, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV ANTIBODY", "code_information": [{"code": "86644", "type": "CPT"}], "standard_charges": [{"minimum": 12.95, "maximum": 584.01, "discounted_cash": 18.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV ANTIBODY IGM", "code_information": [{"code": "86645", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 584.01, "discounted_cash": 21.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNS DNA AMP PROBE TYPE 12-25", "code_information": [{"code": "87483", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 834.71, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 771.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 771.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 834.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 771.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 771.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNVRT NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO GNOTYP AQP1 EXON 1", "code_information": [{"code": "181U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CO/MEMBANE DIFFUSE CAPACITY", "code_information": [{"code": "94729", "type": "CPT"}], "standard_charges": [{"minimum": 70.74, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CO2 CANNULA SSOFT ADLT 7O2 4CO2 FEMALE", "code_information": [{"code": "HCS4561S", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATION DISORDERS", "code_information": [{"code": "813", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5728.24, "maximum": 11624.54, "discounted_cash": 13638.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7672.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7672.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11624.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10184.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6710.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5728.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6908.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME LEE & WHITE", "code_information": [{"code": "85345", "type": "CPT"}], "standard_charges": [{"minimum": 4.22, "maximum": 584.01, "discounted_cash": 6.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME OTR METHOD", "code_information": [{"code": "85348", "type": "CPT"}], "standard_charges": [{"minimum": 4.04, "maximum": 584.01, "discounted_cash": 5.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATOR HARMONIC 5MM X 31 CM BALL TIP", "code_information": [{"code": "HBC05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.43, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATOR SUCTION 10FR 6IN ELECTROSURGICAL", "code_information": [{"code": "E3310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.68, "setting": "both", "billing_class": "facility"}]}, {"description": "COCAINE 4% TOPICAL SOLUTION 4ML", "code_information": [{"code": "MED0244", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 480.36, "setting": "both", "billing_class": "facility"}]}, {"description": "COCCIDIOIDES ANTIBODY", "code_information": [{"code": "86635", "type": "CPT"}], "standard_charges": [{"minimum": 10.32, "maximum": 584.01, "discounted_cash": 14.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCCIDIOIDOMYCOSIS SKIN TEST", "code_information": [{"code": "86490", "type": "CPT"}], "standard_charges": [{"minimum": 5.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM 7/>", "code_information": [{"code": "92603", "type": "CPT"}], "standard_charges": [{"minimum": 200.57, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 200.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM <7", "code_information": [{"code": "92601", "type": "CPT"}], "standard_charges": [{"minimum": 212.18, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 266.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 266.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 288.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 266.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCOON MEMBRANE, PER SQ CM", "code_information": [{"code": "Q4264", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COGENEX AMNIO MEMB PER SQ CM", "code_information": [{"code": "Q4229", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COGNITIVE TEST BY HC PRO", "code_information": [{"code": "96125", "type": "CPT"}], "standard_charges": [{"minimum": 141.58, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COL CHROMOTOGRAPHY QUAL/QUAN", "code_information": [{"code": "82542", "type": "CPT"}], "standard_charges": [{"minimum": 21.68, "maximum": 584.01, "discounted_cash": 31.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ SCREEN", "code_information": [{"code": "86156", "type": "CPT"}], "standard_charges": [{"minimum": 7.26, "maximum": 584.01, "discounted_cash": 10.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ TITER", "code_information": [{"code": "86157", "type": "CPT"}], "standard_charges": [{"minimum": 7.25, "maximum": 584.01, "discounted_cash": 10.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD PACK CUSTOM CSS 12.5 X 18.5IN", "code_information": [{"code": "DSC-NL-12.5X18.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.04, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Diamond Thin Wire 129-0671 10 7 230 2.8", "code_information": [{"code": "CS50011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.66, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Diamond Thin Wire 129-0672 15 7 230 2.8", "code_information": [{"code": "CS50021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.66, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Oval Thin Wire 129-0160 10 7 230 2.8", "code_information": [{"code": "CS50031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.66, "setting": "both", "billing_class": "facility"}]}, {"description": "COLD SNARES Oval Thin Wire 129-0161 15 7 230 2.8", "code_information": [{"code": "CS50041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.66, "setting": "both", "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2662.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2726.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee 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"COLL-E-DERM 1 SQ CM", "code_information": [{"code": "Q4193", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSSLINKS", "code_information": [{"code": "82523", "type": "CPT"}], "standard_charges": [{"minimum": 16.81, "maximum": 584.01, "discounted_cash": 24.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAR CERV THERMOPLAS FOAM 2 PI", "code_information": [{"code": "L0120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.44, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL 13IN TO 22IN X 3IN CHIN REST REG ADLT", "code_information": [{"code": "79-83285", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 108.54, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL 2 1/4IN 13IN TO 22IN NECK SHRT CHIN REST ADLT", "code_information": [{"code": "79-83283", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 97.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL EXTRA TALL 13IN TO 22IN X 4.5IN NECK CHIN REST ADLT", "code_information": [{"code": "79-83288", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 108.01, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL LG 22.5IN X 4.5IN FORM FIT CONTOUR STOCKINETTE COVER FOAM", "code_information": [{"code": "79-83017", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL LRG DME", "code_information": [{"code": "79-83047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.67, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL MED DME", "code_information": [{"code": "79-83015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.56, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL MED LNG 23IN X 4IN FORM FIT DENSE COVER COUNTOUR STOCKINETTE", "code_information": [{"code": "79-83016", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.42, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL MED MIAMI J", "code_information": [{"code": "79-83205", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 124.54, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL MIAMI J MULTIPOST VISTA", "code_information": [{"code": "L0180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL REG CHILD ATLAS", "code_information": [{"code": "79-83278", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 97.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL REG TALL PROCARE TRANSITIONAL 172 ADLT", "code_information": [{"code": "79-83287", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 96.76, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL SEMI RIGID 2 PIECE PREFABRICATED THERMOPLASTIC FOAM IMP", "code_information": [{"code": "L0172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL SEMI RIGID 2 PIECE THERMOPLASTIC FOAM W/ THORACIC EXTENSION", "code_information": [{"code": "L0174", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 937.72, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL SM 18.5IN X 3IN FORMFIT CONTOUR STOCKINETTE COVER FOAM", "code_information": [{"code": "79-83013", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL SM LNG DME", "code_information": [{"code": "79-83014", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 16.42, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CRVCL EXTRA SM 16IN X 2IN FORMFIT VELCRO COVER FRAME DENSE CONTOUR STOCKI", "code_information": [{"code": "79-83012", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CRVCL MED 24IN X 2IN NARROW STOCKINETTE FORM FIT COVER DENSE CONTOUR", "code_information": [{"code": "79-83019", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.56, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CRVCL XL 24IN X 4.5IN FORM FIT DENSE CONTOUR STOCKINETTE COVER FOAM", "code_information": [{"code": "79-83018", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.84, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLECT BLOOD FROM PICC", "code_information": [{"code": "36592", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 3.76, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1480380", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 584.01, "gross_charge": 26.0, "discounted_cash": 12.14, "estimated_discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1006106", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 584.01, "gross_charge": 33.0, "discounted_cash": 12.14, "estimated_discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1006126", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 584.01, "gross_charge": 33.0, "discounted_cash": 12.14, "estimated_discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION: Venous Draw Charge", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "45419337", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 584.01, "gross_charge": 33.0, "discounted_cash": 12.14, "estimated_discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"minimum": 76.24, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLODION 100 ML", "code_information": [{"code": "MED0064", "type": "CDM"}], "standard_charges": [{"gross_charge": 41.61, "setting": "both", "billing_class": "facility"}]}, {"description": "COLON CA SCREEN;BARIUM ENEMA", "code_information": [{"code": "G0106", "type": "HCPCS"}], "standard_charges": [{"minimum": 212.61, "maximum": 229.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN NOT HI RSK IND", "code_information": [{"code": "G0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 502.45, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 212.61, "maximum": 229.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 212.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 282.54, "maximum": 305.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 282.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 282.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 305.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 282.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 282.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 167.06, "maximum": 1270.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 280.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 280.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 302.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 280.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 167.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY & POLYPECTOMY", "code_information": [{"code": "44392", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 571.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY AND BIOPSY", "code_information": [{"code": "45380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 637.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR BLEEDING", "code_information": [{"code": "44391", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 929.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR FOREIGN BODY", "code_information": [{"code": "44390", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 597.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY SUBMUCOUS NJX", "code_information": [{"code": "45381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 650.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THRU STOMA SPX", "code_information": [{"code": "44388", "type": "CPT"}], "standard_charges": [{"minimum": 467.91, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 467.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3498.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BALLOON DILAT", "code_information": [{"code": "45386", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 887.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BAND LIGATION", "code_information": [{"code": "45398", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1190.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/CONTROL BLEED", "code_information": [{"code": "45382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 276.89, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 296.29, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 296.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DILATION", "code_information": [{"code": "44405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 306.99, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPIC FNB", "code_information": [{"code": "45392", "type": "CPT"}], "standard_charges": [{"minimum": 361.06, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/FB REMOVAL", "code_information": [{"code": "45379", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 637.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 616.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45384", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 666.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 327.82, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 327.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 361.42, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 394.63, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 394.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/SNARE", "code_information": [{"code": "44394", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 311.46, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 311.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 343.86, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 343.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 274.53, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 274.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3396.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH BIOPSY", "code_information": [{"code": "44389", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 605.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLORECTAL SCRN; HI RISK IND", "code_information": [{"code": "G0105", "type": "HCPCS"}], "standard_charges": [{"minimum": 502.19, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1475.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1283.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [{"code": "57282", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "429", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37224.1, "maximum": 114808.36, "discounted_cash": 80558.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 75774.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 75774.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 114808.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100587.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 66274.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 56574.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 37224.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC", "code_information": [{"code": "430", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24414.84, "maximum": 75301.43, "discounted_cash": 51565.72, "estimated_discounted_cash": 100108.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49699.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49699.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75301.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 65974.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 43468.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 37106.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24414.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS ADD 30 M", "code_information": [{"code": "G0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.09, "maximum": 73.09, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS SDOH 60MN", "code_information": [{"code": "G0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.53, "maximum": 116.53, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 43.95, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP ASSES CARE PLAN CCM SVC", "code_information": [{"code": "G0506", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.87, "maximum": 89.87, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST INCUBATE", "code_information": [{"code": "86921", "type": "CPT"}], "standard_charges": [{"minimum": 26.92, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL OPH EXAM GENERAL ANES", "code_information": [{"code": "92018", "type": "CPT"}], "standard_charges": [{"minimum": 157.13, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 284.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 284.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 307.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 284.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 157.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL RPLCMT PICC RS&I", "code_information": [{"code": "36584", "type": "CPT"}], "standard_charges": [{"minimum": 406.46, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 406.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT ANTIGEN", "code_information": [{"code": "86160", "type": "CPT"}], "standard_charges": [{"minimum": 10.8, "maximum": 584.01, "discounted_cash": 15.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 9.01, "maximum": 584.01, "discounted_cash": 13.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL (CH50)", "code_information": [{"code": "86162", "type": "CPT"}], "standard_charges": [{"minimum": 18.29, "maximum": 584.01, "discounted_cash": 26.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 37.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT/FUNCTION ACTIVITY", "code_information": [{"code": "86161", "type": "CPT"}], "standard_charges": [{"minimum": 10.8, "maximum": 584.01, "discounted_cash": 15.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE AA, PER SQ CM", "code_information": [{"code": "Q4303", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE ACA, PER SQ CM", "code_information": [{"code": "Q4302", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE FT PER SQ CM", "code_information": [{"code": "Q4271", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE REMOVAL OF VULVA", "code_information": [{"code": "56625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE SL PER SQ CM", "code_information": [{"code": "Q4270", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2929.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEX CYSTOMETROGRAM", "code_information": [{"code": "51726", "type": "CPT"}], "standard_charges": [{"minimum": 244.82, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEX E/M VISIT ADD ON", "code_information": [{"code": "G2211", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.85, "maximum": 23.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4860.65, "maximum": 12466.96, "discounted_cash": 9687.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8228.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8228.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12466.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10922.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7196.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6143.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4860.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8588.15, "maximum": 24278.71, "discounted_cash": 17544.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16024.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16024.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24278.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21271.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14015.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11963.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8588.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3344.13, "maximum": 9265.22, "discounted_cash": 7158.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6115.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6115.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9265.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8117.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5348.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4565.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3344.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4533.96, "maximum": 10109.02, "discounted_cash": 8961.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6672.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6672.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10109.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8856.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5835.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4981.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4533.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8138.73, "maximum": 17268.19, "discounted_cash": 16369.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11397.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11397.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17268.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15129.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9968.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8509.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8138.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3069.21, "maximum": 6923.8, "discounted_cash": 6155.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4569.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4569.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6923.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6066.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3996.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3411.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3069.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPONENT SURG 20MM SZ 7 TO 12 RIGHT PERSONA ULTRACONGRUENT", "code_information": [{"code": "42-5212-006-20", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"minimum": 412.12, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"minimum": 482.26, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 482.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"minimum": 93.8, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE SKIN GRAFT", "code_information": [{"code": "15760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1142.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPR SRS BRCH/STM TRL 10X75MM", "code_information": [{"code": "405118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPRE AUDIOMETRY EVALUATION", "code_information": [{"code": "212T", "type": "CPT"}], "standard_charges": [{"minimum": 77.18, "maximum": 83.35, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL ABLTJ ATR FIB", "code_information": [{"code": "93656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 32680.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1059.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX SVT", "code_information": [{"code": "93653", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 32680.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 934.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX VT", "code_information": [{"code": "93654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 32680.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1126.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM EST PT 1/>", "code_information": [{"code": "92014", "type": "CPT"}], "standard_charges": [{"minimum": 172.32, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 234.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 234.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 252.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 234.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM NEW PT 1/>", "code_information": [{"code": "92004", "type": "CPT"}], "standard_charges": [{"minimum": 203.39, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 281.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 281.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 304.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 281.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 203.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE HEARING TEST", "code_information": [{"code": "92557", "type": "CPT"}], "standard_charges": [{"minimum": 49.3, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPUTER ASSISTED MUSCULOSKELETAL SURGICAL NAVIGATIONAL ORTHO PROCEDURE W/FLUORO 0054T", "code_information": [{"code": "54T", "type": "CPT"}, {"code": "45027709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPUTER ASSISTED SURGICAL NAVIGATION 20985", "code_information": [{"code": "20985", "type": "CPT"}, {"code": "1480016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 164.16, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMT GENE", "code_information": [{"code": "32U", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 255.22, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [{"code": "212", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48619.48, "maximum": 148258.69, "discounted_cash": 97229.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97851.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97851.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 148258.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129894.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 85583.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 73057.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 48619.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION", "code_information": [{"code": "317", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27609.9, "maximum": 85155.8, "discounted_cash": 59786.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 56203.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 56203.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85155.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74607.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49157.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 41962.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 27609.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4784.78, "maximum": 10841.31, "discounted_cash": 9822.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7155.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7155.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10841.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9498.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6258.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5342.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4784.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6295.95, "maximum": 17529.73, "discounted_cash": 12086.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11569.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11569.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17529.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15358.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10119.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8638.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6295.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3513.59, "maximum": 7130.27, "discounted_cash": 7360.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4706.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4706.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7130.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6247.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4116.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3513.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3826.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONDITIONING PLAY AUDIOMETRY", "code_information": [{"code": "92582", "type": "CPT"}], "standard_charges": [{"minimum": 113.66, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 132.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 113.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONGO RED BLOOD TEST", "code_information": [{"code": "P2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 7.23, "discounted_cash": 6.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57520", "type": "CPT"}], "standard_charges": [{"minimum": 475.56, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 475.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57522", "type": "CPT"}], "standard_charges": [{"minimum": 398.25, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5166.82, "maximum": 12570.2, "discounted_cash": 10312.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8296.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8296.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12570.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11013.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7256.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6194.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5166.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11277.55, "maximum": 23761.14, "discounted_cash": 22189.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15682.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15682.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23761.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20817.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13716.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11708.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11277.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3330.29, "maximum": 11891.58, "discounted_cash": 7476.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7848.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7848.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11891.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10418.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6864.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5859.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3330.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTOR IV MICROCLAVE NUETRAL", "code_information": [{"code": "B3300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR PLUS STOPCOCK 360 WHITE BL 394910", "code_information": [{"code": "394910", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR PRECISION 35CM M-1", "code_information": [{"code": "SC-9004-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2567.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SAMPLING GAS STRAIGHT", "code_information": [{"code": "225-3524-804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.71, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SCREW 7601-735155", "code_information": [{"code": "7601-735155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR SPINE 40.0MM ILIAC CLOSED LATERAL", "code_information": [{"code": "1797-98-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2900.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR TUBING FLUID DISPENSE PROXIMAL DISTAL FEMALE LUER LOCK FILL UNIT DOSE LATEX FREE FDC1000 G", "code_information": [{"code": "415080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSLTJ COMPRE RVW REC REPRT", "code_information": [{"code": "88325", "type": "CPT"}], "standard_charges": [{"minimum": 44.52, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 268.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 268.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 290.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 268.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 268.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 211.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT MATRL PREP SLD", "code_information": [{"code": "88323", "type": "CPT"}], "standard_charges": [{"minimum": 38.79, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 71.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT SLD PREP ELSWR", "code_information": [{"code": "88321", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 873.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1589.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1981.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2028.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 976.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2487.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2840.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2702.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 651.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 48.06, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PHYS/QHP EQP", "code_information": [{"code": "95250", "type": "CPT"}], "standard_charges": [{"minimum": 199.18, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 282.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 282.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 304.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 282.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"minimum": 90.79, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT INTRAOP NEURO MONITOR", "code_information": [{"code": "G0453", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.64, "maximum": 67.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"minimum": 134.02, "maximum": 584.01, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 191.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 191.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 207.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 191.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA OU", "code_information": [{"code": "92312", "type": "CPT"}], "standard_charges": [{"minimum": 153.63, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 235.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING FOR TX", "code_information": [{"code": "92071", "type": "CPT"}], "standard_charges": [{"minimum": 49.07, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING OU", "code_information": [{"code": "92310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTAINER DENTURE 8OZ TEAL ORAL CARE NURSING SUPPLY W/ CLR IMPRINTED LID LF", "code_information": [{"code": "DYND70293", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER SPECIMEN 4 OZ NS W SCREW LID", "code_information": [{"code": "CHB8827-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER SPECIMEN 4.5OZ OPERATING ROOM STRL", "code_information": [{"code": "DYND30351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTINUOUS INTRAOP NEUROPHYSIOLOGY MONITORING IN THE O.R. REQ. PERSONAL ATTEND. EA 15 MIN 95940", "code_information": [{"code": "95940", "type": "CPT"}, {"code": "2958404", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 37.12, "maximum": 584.01, "gross_charge": 652.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 892.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM ABDOMINL AORTA", "code_information": [{"code": "75625", "type": "CPT"}], "standard_charges": [{"minimum": 77.75, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 116.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 116.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 126.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 116.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 116.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 77.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75600", "type": "CPT"}], "standard_charges": [{"minimum": 201.48, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 201.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75605", "type": "CPT"}], "standard_charges": [{"minimum": 90.27, "maximum": 584.01, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY BLADDER", "code_information": [{"code": "74430", "type": "CPT"}], "standard_charges": [{"minimum": 31.52, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY GALLBLADDER", "code_information": [{"code": "74290", "type": "CPT"}], "standard_charges": [{"minimum": 67.14, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 67.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 67.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 67.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ANKLE", "code_information": [{"code": "73615", "type": "CPT"}], "standard_charges": [{"minimum": 91.88, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 67.9, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 81.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 113.6, "maximum": 584.01, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ELBOW", "code_information": [{"code": "73085", "type": "CPT"}], "standard_charges": [{"minimum": 90.15, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 90.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 90.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 90.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 90.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF HIP", "code_information": [{"code": "73525", "type": "CPT"}], "standard_charges": [{"minimum": 91.88, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 91.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF KNEE JOINT", "code_information": [{"code": "73580", "type": "CPT"}], "standard_charges": [{"minimum": 111.9, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 130.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF SHOULDER", "code_information": [{"code": "73040", "type": "CPT"}], "standard_charges": [{"minimum": 95.8, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF WRIST", "code_information": [{"code": "73115", "type": "CPT"}], "standard_charges": [{"minimum": 101.87, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 101.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 101.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 110.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 101.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 101.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 139.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL ACCU CHEK  INFORM II 10EA CS 05213509001", "code_information": [{"code": "5213509001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 535.63, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 595.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30901", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30903", "type": "CPT"}], "standard_charges": [{"minimum": 350.49, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 350.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30905", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 519.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL PT I-STAT LEVEL 1", "code_information": [{"code": "6P14-13", "type": "CDM"}], "standard_charges": [{"gross_charge": 215.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42960", "type": "CPT"}], "standard_charges": [{"minimum": 194.42, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 194.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"minimum": 498.59, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 498.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42962", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROLS ACCU-CHEK INFORM II 2 LEVEL", "code_information": [{"code": "521350901A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1122.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY W/ OR W/O GRAFT 27132", "code_information": [{"code": "27132", "type": "CPT"}, {"code": "1807650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 21687.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1985.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21687.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17827.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1143.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONZ OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57461", "type": "CPT"}], "standard_charges": [{"minimum": 461.84, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 461.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOL QUANT SENSORY TEST", "code_information": [{"code": "108T", "type": "CPT"}], "standard_charges": [{"minimum": 111.92, "maximum": 120.87, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT QUAL", "code_information": [{"code": "86885", "type": "CPT"}], "standard_charges": [{"minimum": 5.15, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT TITER", "code_information": [{"code": "86886", "type": "CPT"}], "standard_charges": [{"minimum": 4.66, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1566.0, "discounted_cash": 2262.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1521.83, "discounted_cash": 1365.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1407.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1407.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1521.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1407.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1407.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DOUBLE OSTEOT", "code_information": [{"code": "28299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1378.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DSTL MTAR OSTEO", "code_information": [{"code": "28296", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1178.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS JT ARTHRD", "code_information": [{"code": "28297", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1371.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX MTAR OSTEOT", "code_information": [{"code": "28295", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1411.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX PHLX OSTEOT", "code_information": [{"code": "28298", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1143.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS RSC PRX PHLX BS", "code_information": [{"code": "28292", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 939.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 12.58, "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": 15.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD ELECTROSURGICAL 10FT MONOPOLAR FOOTSWITCH STRL PEDI DISP", "code_information": [{"code": "E0503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.24, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD FORCEPS 12FT BIPOLARFT SWITCHING STRL", "code_information": [{"code": "E0509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1062.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORF RELATED SERV 15 MINS EA", "code_information": [{"code": "G0409", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.35, "maximum": 31.35, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.28, "maximum": 14.28, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 10.32, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1329.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1446.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1451.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65755", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1444.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1348.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY ANGIO S&I", "code_information": [{"code": "93454", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 844.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1602.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1672.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1827.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34884.59, "maximum": 71805.12, "discounted_cash": 68358.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47391.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47391.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71805.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62910.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 41450.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 35383.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 34884.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23744.05, "maximum": 48677.17, "discounted_cash": 48843.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32127.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32127.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48677.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42647.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28099.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 23986.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 23744.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37819.02, "maximum": 83603.1, "discounted_cash": 75374.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 55178.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 55178.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83603.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 73247.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 48260.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 41197.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 37819.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27263.13, "maximum": 62871.64, "discounted_cash": 54207.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41495.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41495.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62871.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55084.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36293.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 30981.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 27263.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "235", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26261.18, "maximum": 65924.71, "discounted_cash": 52473.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43510.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43510.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 65924.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57758.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 38055.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 32485.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 26261.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "236", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18352.3, "maximum": 44074.15, "discounted_cash": 37453.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29089.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29089.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44074.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38614.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25442.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21718.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18352.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "323", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19009.7, "maximum": 56987.1, "discounted_cash": 38692.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37611.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37611.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56987.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49928.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32896.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 28081.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 19009.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "324", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14259.73, "maximum": 40862.78, "discounted_cash": 28174.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26969.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26969.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40862.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35801.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23588.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20136.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14259.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [{"code": "325", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12773.55, "maximum": 36398.79, "discounted_cash": 28705.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24023.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24023.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36398.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31890.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21011.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17936.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12773.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONERS AUTOPSY (NECROPSY)", "code_information": [{"code": "88045", "type": "CPT"}], "standard_charges": [{"minimum": 51.97, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 51.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 51.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPECTOMY EXCISION OF INTRASPINAL LESION SINGLE SEGMENT;EXTRADURAL CERVICAL 63300", "code_information": [{"code": "63300", "type": "CPT"}, {"code": "1480443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2225.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPLEX, PER SQ CM", "code_information": [{"code": "Q4232", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT FINGER DEFORMITY", "code_information": [{"code": "26567", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 923.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1075.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1801.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT METACARPAL FLAW", "code_information": [{"code": "26565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1297.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1179.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 87.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1187.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 674.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1971.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/IMPLT", "code_information": [{"code": "28291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 900.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORSET POST OP FULL", "code_information": [{"code": "L0976", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 484.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTICAL RING 6MM SML CASTLING LYO", "code_information": [{"code": "9406328", "type": "CDM"}], "standard_charges": [{"gross_charge": 1000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTISPORIN BACITRACIN/HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTHALMIC OINTMENT 3.5 GM", "code_information": [{"code": "MED0065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 66.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTISPORIN OTIC 1% 10ML", "code_information": [{"code": "MED0066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 132.33, "setting": "both", "billing_class": "facility"}]}, {"description": "COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD/ THORACIC; SINGLE SEG. 63064", "code_information": [{"code": "63064", "type": "CPT"}, {"code": "30356710", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2155.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUNTER NDL TEN COUNT SNGL MAGNET TYPE NDL SPONGE COUNTER FOAM BLOCK W/ MAGNET L", "code_information": [{"code": "DYNJNC10F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.97, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTER NEEDLE FOAM MAGNET BLADE 20 COUNT", "code_information": [{"code": "NC20FBR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.56, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERNEEDLE 40 80 DBL FM BLCK", "code_information": [{"code": "3FF80SSA", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.11, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER BACK TABLE 44 X 90IN STAND PROCEDURE OPHTHALMOLOGY23IN", "code_information": [{"code": "8146W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.34, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER BOOT REG BLUE GRIPPER KNEE HIGH", "code_information": [{"code": "NON27143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1674.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1500.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE GRN 2EA/ 5160-2FG", "code_information": [{"code": "5160-2FG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.34, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PLASTIC MAYO STAND 22/CS BXT8339", "code_information": [{"code": "BXT8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PROBE GENERAL PURPOSE 6X 48 PC1290", "code_information": [{"code": "PC1290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.81, "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": 0.58, "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": 3.43, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND MAYO 23PLACTIC FOB 30 CS", "code_information": [{"code": "8337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.95, "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": 8.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 50IN X 90IN SURG REINFORCED LF STRL DISP", "code_information": [{"code": "DYNJP2316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.53, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE HVYDTY REINF POLY 65X90 8186", "code_information": [{"code": "8186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.42, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TBL 60IN X 90IN SURG REINFORCED REG DUTY LF STRL DISP", "code_information": [{"code": "DYNJP2320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.72, "setting": "both", "billing_class": "facility"}]}, {"description": "COVID-19 LAB TEST NON-CDC", "code_information": [{"code": "U0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.18, "maximum": 46.18, "discounted_cash": 66.7, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID-19 PCR", "code_information": [{"code": "87635", "type": "CPT"}, {"code": "45692525", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 46.18, "maximum": 584.01, "gross_charge": 57.0, "discounted_cash": 66.7, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID-19 Ql RT-PCR", "code_information": [{"code": "87635", "type": "CPT"}, {"code": "45611846", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 46.18, "maximum": 584.01, "gross_charge": 96.0, "discounted_cash": 66.7, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVIDIEN SPACEMAKER PLUS DISSECTOR SYSTEM WITH 5MM CONVERTER 10MM - 12MM", "code_information": [{"code": "SMSBTRND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1937.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CPK-MB Isoenzyme", "code_information": [{"code": "82552", "type": "CPT"}, {"code": "633713", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 584.01, "gross_charge": 20.0, "discounted_cash": 17.41, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 194.74, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 194.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 105.58, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 105.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 19.52, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 23.03, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6898.01, "maximum": 18136.76, "discounted_cash": 14344.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11970.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11970.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18136.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15890.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10469.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8937.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6898.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4387.24, "maximum": 8903.2, "discounted_cash": 9216.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5876.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5876.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8903.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7800.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5139.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4387.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4652.23, "methodology": "case rate"}], "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": 584.01, "maximum": 6923.0, "gross_charge": 3304.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1321.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1321.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2147.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1553.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2929.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3160.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3942.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13650.53, "maximum": 44013.59, "discounted_cash": 27800.47, "estimated_discounted_cash": 43806.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29049.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29049.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44013.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38561.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25407.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21688.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13650.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19959.87, "maximum": 65522.78, "discounted_cash": 40653.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43245.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43245.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 65522.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57406.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 37823.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 32287.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 19959.87, "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": 11013.79, "maximum": 33498.5, "discounted_cash": 22558.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22109.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22109.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33498.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29349.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19337.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16507.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11013.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30474.7, "maximum": 86294.16, "discounted_cash": 60185.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 56954.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 56954.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86294.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 75605.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49814.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 42523.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 30474.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [{"code": "23", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25461.86, "maximum": 99259.42, "discounted_cash": 51236.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 65511.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 65511.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99259.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86964.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 57298.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 48912.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 25461.86, "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": 16966.99, "maximum": 61530.93, "discounted_cash": 34977.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40610.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40610.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 61530.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53909.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 35519.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 30320.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 16966.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "416U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CAD ALYS 3 PRTN 3 PARAM", "code_information": [{"code": "308U", "type": "CPT"}], "standard_charges": [{"minimum": 351.68, "maximum": 351.68, "discounted_cash": 507.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 75.38, "discounted_cash": 108.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CV DS ALY 4 PRTN PLM ALG", "code_information": [{"code": "309U", "type": "CPT"}], "standard_charges": [{"minimum": 351.68, "maximum": 351.68, "discounted_cash": 507.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 2843.48, "discounted_cash": 4107.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 268.26, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69436", "type": "CPT"}], "standard_charges": [{"minimum": 193.14, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 193.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1014.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"minimum": 220.8, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 220.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 954.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1010.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR SAC DRAIN", "code_information": [{"code": "68720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 949.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 10.68, "maximum": 584.01, "discounted_cash": 15.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE TEST", "code_information": [{"code": "82575", "type": "CPT"}], "standard_charges": [{"minimum": 8.51, "maximum": 584.01, "discounted_cash": 12.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 721.46, "discounted_cash": 1042.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 607.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 607.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 656.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 607.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 607.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2050.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRISIS PSYCHOTHERAPY 60M", "code_information": [{"code": "G0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.04, "maximum": 306.04, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 50", "code_information": [{"code": "G0509", "type": "HCPCS"}], "standard_charges": [{"minimum": 241.64, "maximum": 241.64, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 60", "code_information": [{"code": "G0508", "type": "HCPCS"}], "standard_charges": [{"minimum": 253.19, "maximum": 253.19, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE ADDL 30 MIN", "code_information": [{"code": "99292", "type": "CPT"}], "standard_charges": [{"minimum": 181.3, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE FIRST HOUR", "code_information": [{"code": "99291", "type": "CPT"}], "standard_charges": [{"minimum": 416.46, "maximum": 584.01, "discounted_cash": 1032.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 416.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1257.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT>5 CM DIAM", "code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1423.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1576.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1732.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 439.97, "discounted_cash": 391.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 439.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1180.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSFT KNOTLESS PUNCH 4.75/5.5MM DISPOSABLE", "code_information": [{"code": "CFK-DBP4755", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-303", "code_information": [{"code": "811-303", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-304", "code_information": [{"code": "811-304", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-305", "code_information": [{"code": "811-305", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-306", "code_information": [{"code": "811-306", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-307", "code_information": [{"code": "811-307", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINK LP 5.55MM 811-308", "code_information": [{"code": "811-308", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYO-CORD, PER SQ CM", "code_information": [{"code": "Q4237", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7493.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1471.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "type": "CPT"}], "standard_charges": [{"minimum": 251.36, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATE EACH UNIT", "code_information": [{"code": "P9012", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.06, "maximum": 141.54, "discounted_cash": 88.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 131.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 131.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 141.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 131.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATEREDUCEDPLASMA", "code_information": [{"code": "P9044", "type": "HCPCS"}], "standard_charges": [{"minimum": 172.0, "maximum": 185.76, "discounted_cash": 161.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 185.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3324.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 337.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 71.21, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 12.97, "maximum": 584.01, "discounted_cash": 18.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS NEOFORM AG IA", "code_information": [{"code": "87327", "type": "CPT"}], "standard_charges": [{"minimum": 12.08, "maximum": 584.01, "discounted_cash": 17.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IA", "code_information": [{"code": "87328", "type": "CPT"}], "standard_charges": [{"minimum": 12.44, "maximum": 584.01, "discounted_cash": 17.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF Glu", "code_information": [{"code": "82945", "type": "CPT"}, {"code": "1099836", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.54, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 5.11, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 289.63, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 378.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 378.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 408.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 378.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 378.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 289.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}], "standard_charges": [{"minimum": 339.72, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 395.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 365.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 71.18, "maximum": 4936.0, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 3.6, "maximum": 584.01, "gross_charge": 20.0, "discounted_cash": 5.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 348.47, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 382.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 382.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 413.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 382.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 382.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 348.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 247.35, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 366.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 258.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CTA Chest w/ Contrast  71275", "code_information": [{"code": "71275", "type": "CPT"}, {"code": "44666327", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 258.2, "maximum": 584.01, "gross_charge": 359.0, "discounted_cash": 219.31, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 366.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 258.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CTA Head w/ + w/o Contrast 70496", "code_information": [{"code": "70496", "type": "CPT"}, {"code": "629762", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 253.84, "maximum": 584.01, "gross_charge": 682.0, "discounted_cash": 219.31, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 438.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 438.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 474.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 438.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 438.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 12CM-19CM GREEN WHITE TWO TUBE MATED SOFT CUF PEDI DISP", "code_information": [{"code": "2451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 23CM TO 33 CM NAVY WHITE LONG 2 TB SOFT LATEX FREE ADULT", "code_information": [{"code": "2454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 23CM TO 33CM NAVY WHITE", "code_information": [{"code": "2453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.51, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE 31CM-40CM LRG ROSE WHITE TWO PORT MATED SOFT CUF ADULT", "code_information": [{"code": "2455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.89, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT DISPOSABLE M MP00928", "code_information": [{"code": "MP00928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT LOND DISPOSABLE L MP00931", "code_information": [{"code": "MP00931", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.41, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT LOND DISPOSABLE M+ MP00929", "code_information": [{"code": "MP00929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT LOND DISPOSABLE S MP00926", "code_information": [{"code": "MP00926", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT LONG M+", "code_information": [{"code": "MP00916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE ADULT M", "code_information": [{"code": "MP00915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE L ADULT LRG", "code_information": [{"code": "MP00918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF BLOOD PRESSURE LG ADLT", "code_information": [{"code": "2204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF COLOR NON-STERILE DISPOSABLE TOURNIQUET CUFF 30.0 X 4.0\" 5921-030-235NS", "code_information": [{"code": "5921-030-235NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNIQUET STER DISP DPSB W PLC 30 60707010500", "code_information": [{"code": "60707010500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TOURNQT STERDISP DPSB W PLC 34 60707010600", "code_information": [{"code": "60707010600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF TRNQT 34IN X 4IN 2 PORT SNGL BLADDER SLF CHECK CALIBRATION REPROCESS WITHOU", "code_information": [{"code": "60-7070-106R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CUL TYP ID BLD PTHGN 6+ TRGT", "code_information": [{"code": "87154", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 584.01, "discounted_cash": 283.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 196.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 196.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT EPIDERM GRFT F/N/HFG +%", "code_information": [{"code": "15157", "type": "CPT"}], "standard_charges": [{"minimum": 246.24, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 246.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT F/N/HF/G", "code_information": [{"code": "15155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1122.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"minimum": 201.49, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 201.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 220.12, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 220.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 163.77, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 129.15, "maximum": 1321.17, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1221.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1221.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1321.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1221.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1221.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 129.15, "maximum": 1374.24, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1270.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1270.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1374.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1270.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1270.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC QUANT OTHER", "code_information": [{"code": "87071", "type": "CPT"}], "standard_charges": [{"minimum": 8.9, "maximum": 584.01, "discounted_cash": 12.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE ANAEROBE IDENT EACH", "code_information": [{"code": "87076", "type": "CPT"}], "standard_charges": [{"minimum": 7.27, "maximum": 584.01, "discounted_cash": 10.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIA ANAEROBIC", "code_information": [{"code": "87073", "type": "CPT"}], "standard_charges": [{"minimum": 8.69, "maximum": 584.01, "discounted_cash": 12.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIAL URINE", "code_information": [{"code": "P7001", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.54, "maximum": 25.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE OF SPECIMEN BY KIT", "code_information": [{"code": "87084", "type": "CPT"}], "standard_charges": [{"minimum": 15.86, "maximum": 584.01, "discounted_cash": 35.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOFLUORESC", "code_information": [{"code": "87140", "type": "CPT"}], "standard_charges": [{"minimum": 5.01, "maximum": 584.01, "discounted_cash": 7.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOLOGIC", "code_information": [{"code": "87147", "type": "CPT"}], "standard_charges": [{"minimum": 4.66, "maximum": 584.01, "discounted_cash": 6.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE PULSE FIELD GEL", "code_information": [{"code": "87152", "type": "CPT"}], "standard_charges": [{"minimum": 6.97, "maximum": 584.01, "discounted_cash": 10.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING ADDED METHOD", "code_information": [{"code": "87158", "type": "CPT"}], "standard_charges": [{"minimum": 6.97, "maximum": 584.01, "discounted_cash": 10.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING GLC/HPLC", "code_information": [{"code": "87143", "type": "CPT"}], "standard_charges": [{"minimum": 11.27, "maximum": 584.01, "discounted_cash": 16.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP MEDICINE 2OZ GRADUATED STURDY AND DURABLE PRE PACKAGED PLSTC LF STRL", "code_information": [{"code": "DYNJ05195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE 11G VCF-CCUR-11", "code_information": [{"code": "VCF-CCUR-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1919.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE A13A SIZE 2 T-TIP", "code_information": [{"code": "A13A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1477.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 527.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURRENT PERCEP THRESHOLD TST", "code_information": [{"code": "G0255", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUSHION ULNAR NERVE RASPBERRY PROTECTOR CONVOLUTED FOAM LF", "code_information": [{"code": "NON081340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER DISC 25.4MM DIAMOND", "code_information": [{"code": "MHD-25DD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER ENDO 60MM ECHELON FLEX ENDOPATH POWER FLEX SHAFT", "code_information": [{"code": "PSEE60A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1496.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR 100MM TISSUE RETAINING DIST END SAFETY LOCKOUT PROXIMATE LF", "code_information": [{"code": "TLC10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 678.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR 75MM SAFETY LOCKOUT TLC75", "code_information": [{"code": "TLC75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR POWERED ECHO FLEX 34 MM 34 CM SHAFT", "code_information": [{"code": "PSE45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1254.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR PROXIMATE 75MM LONG TCT75", "code_information": [{"code": "TCT75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.51, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER TOMCAT 4MM REPROCESS FORMULA", "code_information": [{"code": "375-545-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER:ETHICON-ECHELON RELOAD CUTTER VASCULAR35", "code_information": [{"code": "VASECR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CV DS ACS BLD ALG 5 YR SCORE", "code_information": [{"code": "415U", "type": "CPT"}], "standard_charges": [{"minimum": 351.68, "maximum": 351.68, "discounted_cash": 507.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS QUAN ADVSRM/PLSM LPRTN", "code_information": [{"code": "377U", "type": "CPT"}], "standard_charges": [{"minimum": 42.82, "maximum": 42.82, "discounted_cash": 61.85, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOPENTOLATE HCL 2 mg", "code_information": [{"code": "MED0067", "type": "CDM"}], "standard_charges": [{"gross_charge": 29.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CYGNUS DUAL PER SQ CM", "code_information": [{"code": "Q4282", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS MATRIX, PER SQ CM", "code_information": [{"code": "Q4199", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS, PER SQ CM", "code_information": [{"code": "Q4170", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP1A2 GENE", "code_information": [{"code": "31U", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 255.22, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C19 GENE COM VARIANTS", "code_information": [{"code": "81225", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 584.01, "discounted_cash": 378.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 393.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 393.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 426.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 393.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 393.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C9 GENE COM VARIANTS", "code_information": [{"code": "81227", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 3' GENE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 5' GENE DUP/MLT", "code_information": [{"code": "75U", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 658.33, "discounted_cash": 586.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 658.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 FULL GENE SEQUENCE", "code_information": [{"code": "71U", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 439.97, "discounted_cash": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 406.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 406.82, "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 - LIMITED", "standard_charge_dollar": 913.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 987.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 913.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 913.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D6-2D7 HYBRID", "code_information": [{"code": "72U", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 658.33, "discounted_cash": 586.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 658.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D7-2D6 HYBRID", "code_information": [{"code": "73U", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 658.33, "discounted_cash": 586.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 658.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GENE COM VARIANTS", "code_information": [{"code": "81226", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 659.32, "discounted_cash": 586.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 659.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 NONDUPLICATED GENE", "code_information": [{"code": "74U", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 658.33, "discounted_cash": 586.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 658.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A4 GENE COMMON VARIANTS", "code_information": [{"code": "81230", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A5 GENE COMMON VARIANTS", "code_information": [{"code": "81231", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}], "standard_charges": [{"minimum": 16.67, "maximum": 584.01, "discounted_cash": 24.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO IMPL 4 OR MORE", "code_information": [{"code": "C9740", "type": "HCPCS"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO RX BALO CATH URTL STRX", "code_information": [{"code": "52284", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3525.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"minimum": 409.98, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 409.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"minimum": 368.72, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/URETER STRICTURE TX", "code_information": [{"code": "52341", "type": "CPT"}], "standard_charges": [{"minimum": 339.42, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICTURE TX", "code_information": [{"code": "52344", "type": "CPT"}], "standard_charges": [{"minimum": 439.72, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 439.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITHOTRIPSY", "code_information": [{"code": "52356", "type": "CPT"}], "standard_charges": [{"minimum": 494.43, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 494.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "type": "CPT"}], "standard_charges": [{"minimum": 469.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 469.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 294.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY", "code_information": [{"code": "52000", "type": "CPT"}], "standard_charges": [{"minimum": 285.78, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 484.6, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 484.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52270", "type": "CPT"}], "standard_charges": [{"minimum": 530.73, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER CATHETER", "code_information": [{"code": "52005", "type": "CPT"}], "standard_charges": [{"minimum": 372.68, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 372.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND BIOPSY", "code_information": [{"code": "52007", "type": "CPT"}], "standard_charges": [{"minimum": 571.81, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 571.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 286.74, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52214", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52224", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1005.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52234", "type": "CPT"}], "standard_charges": [{"minimum": 293.65, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52235", "type": "CPT"}], "standard_charges": [{"minimum": 344.65, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 344.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52240", "type": "CPT"}], "standard_charges": [{"minimum": 466.14, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 466.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52260", "type": "CPT"}], "standard_charges": [{"minimum": 250.98, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 250.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52265", "type": "CPT"}], "standard_charges": [{"minimum": 458.2, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 458.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52276", "type": "CPT"}], "standard_charges": [{"minimum": 316.27, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 385.82, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 385.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52281", "type": "CPT"}], "standard_charges": [{"minimum": 412.46, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"minimum": 443.16, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"minimum": 433.91, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52290", "type": "CPT"}], "standard_charges": [{"minimum": 291.77, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 291.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52300", "type": "CPT"}], "standard_charges": [{"minimum": 334.82, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 334.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 345.79, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"minimum": 331.75, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 331.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52310", "type": "CPT"}], "standard_charges": [{"minimum": 396.97, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 396.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 610.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52320", "type": "CPT"}], "standard_charges": [{"minimum": 293.35, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 784.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52332", "type": "CPT"}], "standard_charges": [{"minimum": 494.2, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 494.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [{"code": "52287", "type": "CPT"}], "standard_charges": [{"minimum": 482.75, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 482.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY IMPLANT STENT", "code_information": [{"code": "52282", "type": "CPT"}], "standard_charges": [{"minimum": 401.29, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"minimum": 305.75, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 305.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [{"code": "52001", "type": "CPT"}], "standard_charges": [{"minimum": 560.94, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 381.39, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 381.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY W/BIOPSY(S)", "code_information": [{"code": "52204", "type": "CPT"}], "standard_charges": [{"minimum": 470.83, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 470.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [{"code": "52351", "type": "CPT"}], "standard_charges": [{"minimum": 361.24, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/BIOPSY", "code_information": [{"code": "52354", "type": "CPT"}], "standard_charges": [{"minimum": 496.19, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 496.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"minimum": 578.86, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 578.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/EXCISE TUMOR", "code_information": [{"code": "52355", "type": "CPT"}], "standard_charges": [{"minimum": 555.43, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/LITHOTRIPSY", "code_information": [{"code": "52353", "type": "CPT"}], "standard_charges": [{"minimum": 466.14, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 466.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"minimum": 530.45, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/STONE REMOVE", "code_information": [{"code": "52352", "type": "CPT"}], "standard_charges": [{"minimum": 422.09, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 422.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"minimum": 313.4, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 313.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/ADDL IMPLANT", "code_information": [{"code": "52442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/IMPLANT", "code_information": [{"code": "52441", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1641.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTURETH BLU LI CYST FL IMG", "code_information": [{"code": "C7554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR CGH", "code_information": [{"code": "81228", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 810.0, "discounted_cash": 1170.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR LW-PS", "code_information": [{"code": "81349", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1044.0, "discounted_cash": 1557.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR SNPCGH", "code_information": [{"code": "81229", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4234.0, "discounted_cash": 1508.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3915.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3915.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4234.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3915.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3915.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG CONST ALYS INTERROG", "code_information": [{"code": "209U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 708.44, "discounted_cash": 1023.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 708.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 708.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 10-30", "code_information": [{"code": "88273", "type": "CPT"}], "standard_charges": [{"minimum": 31.33, "maximum": 584.01, "discounted_cash": 45.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 73.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 73.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 25-99", "code_information": [{"code": "88274", "type": "CPT"}], "standard_charges": [{"minimum": 38.14, "maximum": 584.01, "discounted_cash": 55.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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"standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS DNA PROBE", "code_information": [{"code": "88271", "type": "CPT"}], "standard_charges": [{"minimum": 19.28, "maximum": 584.01, "discounted_cash": 27.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOGENOMIC NEO MICRORA ALYS", "code_information": [{"code": "81277", "type": "CPT"}], 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"plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87164", "type": "CPT"}], "standard_charges": [{"minimum": 8.56, "maximum": 584.01, "discounted_cash": 13.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", 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"type": "CPT"}], "standard_charges": [{"minimum": 8.56, "maximum": 584.01, "discounted_cash": 14.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBD-MASK SURGICAL ANTI-FOG GREEN 28806", "code_information": [{"code": "28806", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.57, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF-SEE BXT2D73EB85BX GLOVE SURG POLYISO 2D73EB85", "code_information": [{"code": "2D73EB85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF-SEE BXTSU1300321 DRAIN JACKSON PRATT SU130-0321", "code_information": [{"code": "SU130-0321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DBRDMT BONE 1ST 20 SQ CM/<", "code_information": [{"code": "11044", "type": "CPT"}], "standard_charges": [{"minimum": 426.37, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 590.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 590.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 637.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 590.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 426.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"minimum": 170.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 232.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 232.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 251.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 232.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "type": "CPT"}], "standard_charges": [{"minimum": 36.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFECTED SKIN<10%", "code_information": [{"code": "11000", "type": "CPT"}], "standard_charges": [{"minimum": 79.18, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA 1ST 20/<", "code_information": [{"code": "11043", "type": "CPT"}], "standard_charges": [{"minimum": 318.35, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 425.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 425.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 459.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 425.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 318.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA EA ADDL", "code_information": [{"code": "11046", "type": "CPT"}], "standard_charges": [{"minimum": 101.24, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 147.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND 1ST 20 CM/<", "code_information": [{"code": "97597", "type": "CPT"}], "standard_charges": [{"minimum": 135.49, "maximum": 1270.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 140.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 140.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 151.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 140.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND ADDL 20CM/<", "code_information": [{"code": "97598", "type": "CPT"}], "standard_charges": [{"minimum": 46.62, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 63.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT PRMLG LES W/PDT", "code_information": [{"code": "96574", "type": "CPT"}], "standard_charges": [{"minimum": 353.39, "maximum": 1100.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 453.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 453.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 489.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 453.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 353.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN ABDOMINAL WALL", "code_information": [{"code": "11005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 823.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT&PER", "code_information": [{"code": "11004", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TIS 1ST 20SQCM/<", "code_information": [{"code": "11042", "type": "CPT"}], "standard_charges": [{"minimum": 176.21, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 214.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 214.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 231.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 214.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "type": "CPT"}], "standard_charges": [{"minimum": 56.05, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 84.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEB BONE 20 CM2 W/DRUG DEV", "code_information": [{"code": "C7500", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEB SKIN BONE AT FX SITE", "code_information": [{"code": "11012", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "11720", "type": "CPT"}], "standard_charges": [{"minimum": 43.72, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "11721", "type": "CPT"}], "standard_charges": [{"minimum": 60.54, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN AT FX SITE", "code_information": [{"code": "11010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 619.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN MUSC AT FX SITE", "code_information": [{"code": "11011", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECANTER 3 TRANSFER DYNJDEC03", "code_information": [{"code": "DYNJDEC03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DECANTER 6 VIAL DYNJDEC06", "code_information": [{"code": "DYNJDEC06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DECANTER 9 BAG DYNJDEC09", "code_information": [{"code": "DYNJDEC09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.41, "setting": "both", "billing_class": "facility"}]}, {"description": "DECANTER 9\" BAG", "code_information": [{"code": "DYNJDEC09H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DECLOT VASCULAR DEVICE", "code_information": [{"code": "36593", "type": "CPT"}], "standard_charges": [{"minimum": 49.55, "maximum": 4936.0, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2232.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1075.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 697.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25023", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1667.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 959.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1484.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1494.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1190.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 236.16, "maximum": 6887.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 236.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1193.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 683.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27893", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 774.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27894", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 997.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27600", "type": "CPT"}], "standard_charges": [{"minimum": 496.45, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 496.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "type": "CPT"}], "standard_charges": [{"minimum": 553.93, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 553.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27602", "type": "CPT"}], "standard_charges": [{"minimum": 581.56, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 581.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 727.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 824.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 875.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF TIBIA NERVE", "code_information": [{"code": "28035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION;UNSPECIFIED NERVE(S) 64722", "code_information": [{"code": "64722", "type": "CPT"}, {"code": "1480599", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 489.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2913.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2904.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC", "code_information": [{"code": "294", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5480.56, "maximum": 15777.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10413.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10413.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15777.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13823.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9107.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7774.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5480.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC", "code_information": [{"code": "295", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2644.01, "maximum": 5365.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3541.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3541.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5365.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4700.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3097.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2644.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3524.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7252.38, "maximum": 14717.54, "discounted_cash": 20771.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9713.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9713.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14717.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12894.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8495.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7252.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11175.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5410.8, "maximum": 10980.34, "discounted_cash": 11584.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7247.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7247.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10980.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9620.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6338.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5410.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5955.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82626", "type": "CPT"}], "standard_charges": [{"minimum": 22.74, "maximum": 584.01, "discounted_cash": 32.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 46.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82627", "type": "CPT"}], "standard_charges": [{"minimum": 20.01, "maximum": 584.01, "discounted_cash": 28.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP ARMS/LEGS", "code_information": [{"code": "15610", "type": "CPT"}], "standard_charges": [{"minimum": 516.37, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 516.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP EYE/NOS/EAR/LIP", "code_information": [{"code": "15630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 623.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP F/C/C/N/AX/G/H/F", "code_information": [{"code": "15620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 613.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP TRUNK", "code_information": [{"code": "15600", "type": "CPT"}], "standard_charges": [{"minimum": 491.87, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 491.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"minimum": 105.8, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 105.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 434.63, "maximum": 470.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 434.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 434.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 470.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 434.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 434.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEMONSTRATE USE HOME INR MON", "code_information": [{"code": "G0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 137.45, "maximum": 137.45, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENERVATION OF HIP JOINT", "code_information": [{"code": "27035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1415.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 2 DOSE SUBQ", "code_information": [{"code": "90584", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 3 DOSE SUBQ", "code_information": [{"code": "90587", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4197.9, "maximum": 11378.15, "discounted_cash": 8134.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7509.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7509.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11378.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9968.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6568.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5606.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4197.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7308.16, "maximum": 21023.28, "discounted_cash": 15350.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13875.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13875.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21023.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18419.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12135.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10359.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7308.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2943.79, "maximum": 9894.28, "discounted_cash": 6334.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6530.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6530.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9894.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8668.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5711.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4875.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2943.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEOXYCORTISOL", "code_information": [{"code": "82634", "type": "CPT"}], "standard_charges": [{"minimum": 26.35, "maximum": 584.01, "discounted_cash": 38.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 58.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEOXYRIBONUCLEASE ANTIBODY", "code_information": [{"code": "86215", "type": "CPT"}], "standard_charges": [{"minimum": 11.93, "maximum": 584.01, "discounted_cash": 17.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 40MG/ML", "code_information": [{"code": "MED0068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.71, "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": 52.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSION SCREEN ANNUAL", "code_information": [{"code": "G0444", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.13, "maximum": 25.13, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3030.64, "maximum": 6150.2, "discounted_cash": 8412.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4059.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4059.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6150.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5388.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3550.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3030.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4079.63, "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": 0.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSOR TONGUE ADULT NON STERILE 6", "code_information": [{"code": "C15063-006", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 134.84, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1199.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 136.59, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM-MAXX, PER SQ CM", "code_information": [{"code": "Q4238", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMA-FAT-FASCIA GRAFT", "code_information": [{"code": "15770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 807.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMA-GIDE, 1 SQ CM", "code_information": [{"code": "Q4203", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABIND CH, PER SQ CM", "code_information": [{"code": "Q4288", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABIND DL, PER SQ CM", "code_information": [{"code": "Q4287", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABIND SL, PER SQ CM", "code_information": [{"code": "Q4284", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 692.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1107.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMACELL, AWM, POROUS SQ CM", "code_information": [{"code": "Q4122", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMACYTE AMN MEM ALLO SQ CM", "code_information": [{"code": "Q4248", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"minimum": 133.23, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 133.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAPURE 1 SQUARE CM", "code_information": [{"code": "Q4152", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAVEST, PLURIVEST SQ CM", "code_information": [{"code": "Q4153", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 384.51, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIGN MLC DEVICE FOR IMRT", "code_information": [{"code": "77338", "type": "CPT"}], "standard_charges": [{"minimum": 329.55, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 337.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 337.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 364.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 337.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 337.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 329.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 27.88, "maximum": 584.01, "discounted_cash": 40.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 327.8, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 327.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE FACE MUSCLE", "code_information": [{"code": "64612", "type": "CPT"}], "standard_charges": [{"minimum": 186.44, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 332.58, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"minimum": 216.31, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS COMPLEX", "code_information": [{"code": "57065", "type": "CPT"}], "standard_charges": [{"minimum": 320.27, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS SIMPLE", "code_information": [{"code": "57061", "type": "CPT"}], "standard_charges": [{"minimum": 215.71, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION/S COMPL", "code_information": [{"code": "56515", "type": "CPT"}], "standard_charges": [{"minimum": 362.14, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESIONS SIM", "code_information": [{"code": "56501", "type": "CPT"}], "standard_charges": [{"minimum": 244.82, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT B9 LESION 1-14", "code_information": [{"code": "17110", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 15 OR MORE", "code_information": [{"code": "17111", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"minimum": 8.49, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 88.64, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"minimum": 355.5, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46910", "type": "CPT"}], "standard_charges": [{"minimum": 391.99, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 391.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46924", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 819.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEURO AGENT PARAVERT FACET W/IMAGE CERV.OR THOR. SINGLE 64633", "code_information": [{"code": "64633", "type": "CPT"}, {"code": "1807636", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "gross_charge": 2294.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 917.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1376.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1491.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 610.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 546.14, "maximum": 4936.0, "gross_charge": 2907.5, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1163.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1744.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1889.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.14, "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": 355.64, "maximum": 4936.0, "gross_charge": 2682.5, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1073.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1609.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1743.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JT NERVE W/ IMAGE LUMB/SACRAL EACH 64636", "code_information": [{"code": "64636", "type": "CPT"}, {"code": "1582413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 332.65, "maximum": 4936.0, "gross_charge": 980.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 637.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGT PARARVERT FACET JT W/IMAGE LUM/SAC  SINGLE JT 64635", "code_information": [{"code": "64635", "type": "CPT"}, {"code": "1481273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 2671.5, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1068.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1602.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1736.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 618.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 613.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 596.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION NEURO AGENT EA ADD FACET JT CERVICAL/THORACIC W/GUIDE 64634", "code_information": [{"code": "64634", "type": "CPT"}, {"code": "1643974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 352.87, "maximum": 4936.0, "gross_charge": 980.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 637.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17106", "type": "CPT"}], "standard_charges": [{"minimum": 456.57, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 456.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 591.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 844.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 194.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54055", "type": "CPT"}], "standard_charges": [{"minimum": 185.41, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54065", "type": "CPT"}], "standard_charges": [{"minimum": 298.1, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 900.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA AMP", "code_information": [{"code": "87798", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA DIR", "code_information": [{"code": "87797", "type": "CPT"}], "standard_charges": [{"minimum": 27.03, "maximum": 584.01, "discounted_cash": 39.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 27.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 27.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA QUANT", "code_information": [{"code": "87799", "type": "CPT"}], "standard_charges": [{"minimum": 38.56, "maximum": 584.01, "discounted_cash": 55.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA DIREC", "code_information": [{"code": "87800", "type": "CPT"}], "standard_charges": [{"minimum": 39.3, "maximum": 584.01, "discounted_cash": 56.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 73.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 73.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 79.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 73.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 73.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECTOR CO2 EASY ADULT", "code_information": [{"code": "562134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 49.55, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 172.9, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}], "standard_charges": [{"minimum": 78.1, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 78.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "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": 142.31, "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": 362.79, "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": 223.44, "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": 219.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE EXTENDED NOZZLE WITH EDGE ELECTRODE10 IN LONG VSMP10", "code_information": [{"code": "VSMP10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATE SUTURING  MB365FB101010", "code_information": [{"code": "MB365FB101010", "type": "CDM"}], "standard_charges": [{"gross_charge": 1212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATE SUTURING M365FB201010", "code_information": [{"code": "M365FB201010", "type": "CDM"}], "standard_charges": [{"gross_charge": 2424.0, "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": 1473.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE HANDLING PHYS/QHP", "code_information": [{"code": "99002", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVICE LANCET SAFE T PRO STRL", "code_information": [{"code": "313675200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE MARYLAND JAW LAPAROSCOPIC LF1944", "code_information": [{"code": "LF1944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2220.46, "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": 18.37, "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": 1.58, "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": 83.16, "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": 511.93, "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": 130.77, "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": 99.72, "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": 112.23, "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": 121.41, "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": 69.71, "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": 95.94, "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": 123.47, "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": 142.31, "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": 159.4, "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": 150.86, "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": 112.16, "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": 117.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1726.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.02, "maximum": 16.02, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 121.85, "maximum": 584.01, "discounted_cash": 210.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 121.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 121.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 131.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 121.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 121.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 145.69, "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": 3.56, "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": 3.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DGP ANTIBODY EACH IG CLASS", "code_information": [{"code": "86258", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN  PER INDIV", "code_information": [{"code": "G0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.34, "maximum": 109.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 101.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 101.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 109.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 101.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN IND/GROUP", "code_information": [{"code": "G0109", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.93, "maximum": 30.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3975.52, "maximum": 8067.67, "discounted_cash": 8013.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5324.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5324.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8067.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7068.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4657.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3975.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4093.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5893.75, "maximum": 11960.41, "discounted_cash": 12846.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7893.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7893.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11960.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10478.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6904.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5893.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6499.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2749.83, "maximum": 5580.33, "discounted_cash": 5554.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3683.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3683.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5580.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4889.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3221.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2749.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2796.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 209.52, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 209.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAG LAPARO SEPARATE PROC", "code_information": [{"code": "49320", "type": "CPT"}], "standard_charges": [{"minimum": 414.53, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 220.67, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 220.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 306.57, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC COLONOSCOPY", "code_information": [{"code": "45378", "type": "CPT"}], "standard_charges": [{"minimum": 502.19, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 117.35, "maximum": 4936.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31575", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC SIGMOIDOSCOPY", "code_information": [{"code": "45330", "type": "CPT"}], "standard_charges": [{"minimum": 283.83, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2388.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ONE EVALUATION", "code_information": [{"code": "90945", "type": "CPT"}], "standard_charges": [{"minimum": 106.19, "maximum": 584.01, "discounted_cash": 521.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"minimum": 146.95, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING COMPLETE", "code_information": [{"code": "90989", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 9.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [{"code": "375", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5483.69, "maximum": 17931.67, "discounted_cash": 10815.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11835.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11835.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17931.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15710.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10351.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8836.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5483.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9423.18, "maximum": 29114.35, "discounted_cash": 19122.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19215.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19215.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29114.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25508.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16806.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14346.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9423.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3940.83, "maximum": 16464.32, "discounted_cash": 8264.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10866.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10866.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16464.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14424.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9504.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8113.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3940.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "type": "CPT"}], "standard_charges": [{"minimum": 204.95, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 204.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}], "standard_charges": [{"minimum": 26.35, "maximum": 584.01, "discounted_cash": 38.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"minimum": 184.23, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 184.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"minimum": 304.29, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 630.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1093.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS 1/MULT PASS", "code_information": [{"code": "43450", "type": "CPT"}], "standard_charges": [{"minimum": 281.23, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 281.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53600", "type": "CPT"}], "standard_charges": [{"minimum": 122.01, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53601", "type": "CPT"}], "standard_charges": [{"minimum": 119.4, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53605", "type": "CPT"}], "standard_charges": [{"minimum": 75.72, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53620", "type": "CPT"}], "standard_charges": [{"minimum": 231.01, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53621", "type": "CPT"}], "standard_charges": [{"minimum": 221.65, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE", "code_information": [{"code": "58120", "type": "CPT"}], "standard_charges": [{"minimum": 395.09, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 395.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 224.04, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF CERVICAL CANAL", "code_information": [{"code": "57800", "type": "CPT"}], "standard_charges": [{"minimum": 97.97, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF RECTAL NARROWING", "code_information": [{"code": "45910", "type": "CPT"}], "standard_charges": [{"minimum": 250.07, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 250.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 102.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 102.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 104.92, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 104.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"minimum": 103.2, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"minimum": 44.98, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 154.18, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION URTR/URT RS&I", "code_information": [{"code": "74485", "type": "CPT"}], "standard_charges": [{"minimum": 86.24, "maximum": 584.01, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 93.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATOR SET TEDAN 1100-0028", "code_information": [{"code": "1100-0028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1999.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SET TROCAR DIRECT LATERAL DIALATOR", "code_information": [{"code": "945NSD2750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1999.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTIBODY", "code_information": [{"code": "86648", "type": "CPT"}], "standard_charges": [{"minimum": 13.69, "maximum": 584.01, "discounted_cash": 19.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}], "standard_charges": [{"minimum": 12.19, "maximum": 584.01, "discounted_cash": 17.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT ADVANCED LIFE SUPPORT", "code_information": [{"code": "99288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISABILITY EXAMINATION", "code_information": [{"code": "99456", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHO SEC CLSR", "code_information": [{"code": "23921", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 604.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1365.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR W/DEC OF SPINAL CORD AND/OR ROOT W/OST 63076", "code_information": [{"code": "63076", "type": "CPT"}, {"code": "1700056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 279.27, "maximum": 6887.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 279.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR WITH DECOMPRESSION; CERVICAL SINGLE INTERSPACE 63075", "code_information": [{"code": "63075", "type": "CPT"}, {"code": "1480659", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 7723.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 7723.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1658.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCECTOMY ANTERIOR WITH DECOMPRESSION; THORACIC SINGLE INTERSPACE 63077", "code_information": [{"code": "63077", "type": "CPT"}, {"code": "1480660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCOGRAPHY CERV/THOR SPINE", "code_information": [{"code": "72285", "type": "CPT"}], "standard_charges": [{"minimum": 66.26, "maximum": 584.01, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISE EVAL SLP DO BRTH FLX DX", "code_information": [{"code": "42975", "type": "CPT"}], "standard_charges": [{"minimum": 112.45, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5967.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5094.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3839.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7425.09, "maximum": 17646.73, "discounted_cash": 14576.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11646.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11646.97, "methodology": "case 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4443.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4443.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6732.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5898.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3886.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3317.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2745.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [{"code": "883", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5811.0, "maximum": 11792.48, "discounted_cash": 17581.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7783.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7783.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11792.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10331.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6807.34, "methodology": "case rate"}, {"payer_name": "BLUE 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SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11793.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7770.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6633.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4840.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7517.48, "maximum": 16705.2, "discounted_cash": 14940.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11025.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11025.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16705.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14636.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9643.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8231.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7517.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3558.35, "maximum": 10220.51, "discounted_cash": 7397.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6745.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6745.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10220.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8954.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5899.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5036.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3558.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISPENSING PIN SAFSITE 2-WAY VALVE 413501", "code_information": [{"code": "413501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.27, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KERRISON 1MM S125", "code_information": [{"code": "S125", "type": "CDM"}], "standard_charges": [{"gross_charge": 478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KERRISON 2MM S126", "code_information": [{"code": "S126", "type": "CDM"}], "standard_charges": [{"gross_charge": 478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KERRISON 3MM S127", "code_information": [{"code": "S127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KERRISON 4MM S137", "code_information": [{"code": "S137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPOSABLE KERRISON 5MM S138", "code_information": [{"code": "S138", "type": "CDM"}], "standard_charges": [{"gross_charge": 404.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSECTOR BALLOON TROCAR SPACEMAKER", "code_information": [{"code": "OMSXB2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.45, "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": 1721.61, "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": 885.41, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOPATH CURVE 5MM -ORDR QTY 6 5DCD", "code_information": [{"code": "5DCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOSCOPIC 5MM 176645", "code_information": [{"code": "176645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR LAP 5MM TIP KITTNER LF STRL", "code_information": [{"code": "28-0801 kittner", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR SONICISION CORDLESS ULTRASONIC 39CM 14.5MM BLADE", "code_information": [{"code": "SCD396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2913.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ULTRASONIC 48CM SONICISION CORDLESS", "code_information": [{"code": "SCD48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3292.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92975", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92977", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1346.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "type": "CPT"}], "standard_charges": [{"minimum": 442.59, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 442.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"minimum": 402.49, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 945.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"minimum": 345.79, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}], "standard_charges": [{"minimum": 251.1, "maximum": 584.01, "discounted_cash": 362.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 407.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME SUPPLY OR ACCESSORY, NOS", 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CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS APOE ALZHEIMER", "code_information": [{"code": "S3852", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS DEAFNESS", "code_information": [{"code": "S3844", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY NATIVE", "code_information": [{"code": "86225", "type": "CPT"}], "standard_charges": [{"minimum": 12.37, "maximum": 584.01, "discounted_cash": 17.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY SINGLE STRAND", "code_information": [{"code": "86226", "type": "CPT"}], "standard_charges": [{"minimum": 10.9, "maximum": 584.01, "discounted_cash": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA Test For Detecting Gene Abnormality Associated With Blood And Lymphatic System Cancer In Blood Or Bone Marrow", "code_information": [{"code": "14U", "type": "CPT"}], "standard_charges": [{"minimum": 3396.06, "maximum": 3672.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3672.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3396.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA AMPLIFIED PROBE", "code_information": [{"code": "87150", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee 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"facility"}]}, {"description": "DNA/RNA DIRECT PROBE", "code_information": [{"code": "87149", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA SEQUENCING", "code_information": [{"code": "87153", "type": "CPT"}], "standard_charges": [{"minimum": 103.82, "maximum": 584.01, "discounted_cash": 149.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 103.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 103.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DO GNOTYP ART4 EXON 2", "code_information": [{"code": "184U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC SYS RSN <3 COLON", "code_information": [{"code": "G9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER COLOR FLOW ADD-ON", "code_information": [{"code": "93325", "type": "CPT"}], "standard_charges": [{"minimum": 26.71, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93320", "type": "CPT"}], "standard_charges": [{"minimum": 44.47, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93321", "type": "CPT"}], "standard_charges": [{"minimum": 23.65, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER FLOW TESTING", "code_information": [{"code": "93990", "type": "CPT"}], "standard_charges": [{"minimum": 159.7, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 354.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4521.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAGERSORB 800 PLUS 5L MX00001", "code_information": [{"code": "MX00001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 10FR RND CHANNEL FULL FLUTED", "code_information": [{"code": "70900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 19FR ROUND 1/4\" TROCAR 2231", "code_information": [{"code": "2231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BL W/CATH INSERTION", "code_information": [{"code": "51102", "type": "CPT"}], "standard_charges": [{"minimum": 321.71, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"minimum": 99.35, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN BLAKE HBLS 15FR W BND 2233", "code_information": [{"code": "2233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 270.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHANNEL SILICONE 19FR 072230", "code_information": [{"code": "72230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69000", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 295.35, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 295.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN FLAT KIT 10 MM 100 CC EVACUATOR PERFORATED BRD0071370", "code_information": [{"code": "BRD0071370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.81, "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": 72.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN HAND TENDON SHEATH", "code_information": [{"code": "26020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 703.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG BURSA", "code_information": [{"code": "27604", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG LESION", "code_information": [{"code": "27603", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1252.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1451.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1348.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 403.53, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 403.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 843.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1361.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 374.49, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 374.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 0.25IN X 18IN CLOSED WOUND DRAIN WOUND CARE LATEX STRL", "code_information": [{"code": "DYND50420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.82, "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": 5.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 18IN LATEX FREE DYND50427", "code_information": [{"code": "DYND50427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PVC ROUND MIDPERF TROCAR 1/8IN", "code_information": [{"code": "80710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RESERVOIR 100CC CLR EVACUATOR BULB JACKSON-PRATT SILICONE 70740 (USE 0070740 PART NUMBER)", "code_information": [{"code": "70740 (USE 0070740 PART NUMBER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RND 1/8IN X 49IN 10IN ROUND PERFORATED RADIOPAQUE SILICONE END LF STRL", "code_information": [{"code": "70210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.6, "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": 22.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL FULL-FLUTED 10FR 072186", "code_information": [{"code": "72186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 15FR 072189", "code_information": [{"code": "72189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 611.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER LESION", "code_information": [{"code": "23030", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 623.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 239.92, "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": 37.51, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 402.68, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN THIGH/KNEE LESION", "code_information": [{"code": "27301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 947.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 248.41, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 956.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM 3/16IN SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 257.24, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 15FR ROUND WITHOUT TROCAR", "code_information": [{"code": "SU130-1323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND PENROSE SAFTEY PIN 12 X 1/4", "code_information": [{"code": "zz30414-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 10FR SILICONE HUBLESS ETHICON BLAKE STRL", "code_information": [{"code": "2226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 19FR SILICONE HUBLESS BLAKE", "code_information": [{"code": "2230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND SILICONE 10FR 1 8 SU130 1321", "code_information": [{"code": "SU130-1321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.29, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 116.11, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "type": "CPT"}], "standard_charges": [{"minimum": 125.61, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20611", "type": "CPT"}], "standard_charges": [{"minimum": 138.78, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1950.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 495.63, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 495.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 641.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 211.96, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 211.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2277.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 606.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 797.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BURSA OF FOOT", "code_information": [{"code": "28001", "type": "CPT"}], "standard_charges": [{"minimum": 224.66, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65800", "type": "CPT"}], "standard_charges": [{"minimum": 162.43, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65810", "type": "CPT"}], "standard_charges": [{"minimum": 542.34, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 542.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"minimum": 372.24, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 372.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26010", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 493.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26011", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 680.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"minimum": 479.45, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 479.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM LESION", "code_information": [{"code": "25028", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GLAND ABSCESS", "code_information": [{"code": "56420", "type": "CPT"}], "standard_charges": [{"minimum": 240.44, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 503.82, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 503.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": "55000", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 110.56, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40800", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 407.91, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 407.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 211.83, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 211.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 305.7, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 305.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 464.99, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 464.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 448.53, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 549.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 575.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41017", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58800", "type": "CPT"}], "standard_charges": [{"minimum": 468.78, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 468.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"minimum": 507.27, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 507.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSA", "code_information": [{"code": "26025", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSAS", "code_information": [{"code": "26030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 616.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "57010", "type": "CPT"}], "standard_charges": [{"minimum": 543.72, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC FLUID", "code_information": [{"code": "57020", "type": "CPT"}], "standard_charges": [{"minimum": 158.66, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 158.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS BURSA", "code_information": [{"code": "26991", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 981.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS LESION", "code_information": [{"code": "26990", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"minimum": 547.27, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55720", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 736.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45005", "type": "CPT"}], "standard_charges": [{"minimum": 480.65, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 480.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 730.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 512.34, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 285.31, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 515.18, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 515.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 242.86, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 242.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 346.79, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM", "code_information": [{"code": "54700", "type": "CPT"}], "standard_charges": [{"minimum": 268.46, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM ABSCESS", "code_information": [{"code": "55100", "type": "CPT"}], "standard_charges": [{"minimum": 328.96, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 328.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1772.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2149.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 596.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 946.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF TONSIL ABSCESS", "code_information": [{"code": "42700", "type": "CPT"}], "standard_charges": [{"minimum": 263.42, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 263.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 488.35, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 253.37, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 524.48, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 524.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 797.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE SYSTEM NO VENT CATH 821731C", "code_information": [{"code": "821731C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1651.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE  INCISE  ANTIMICROBL 23 X 17 6650EZ", "code_information": [{"code": "6650EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE 150X54IN MSCP EQP WLD VMD50-5415", "code_information": [{"code": "VMD50-5415", "type": "CDM"}], "standard_charges": [{"gross_charge": 64.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE 36 INCHWX44 INCHL FLURO", "code_information": [{"code": "3644-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE 9  I.I. FITTED SHWCAP VMC60-5411", "code_information": [{"code": "VMC60-5411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ASTOUND 3 QTR SHEET", "code_information": [{"code": "9349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.46, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BACK TABLE 65IN X 90IN EQUIPMENT COVER", "code_information": [{"code": "8386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.49, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM BANDS 41X120", "code_information": [{"code": "DYNJE4400XLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 34.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM MOBILE XRAY W TIES 42X74 VAE5601", "code_information": [{"code": "VAE5601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE CAMERA ARM 5IN X 96IN VIDEO CAMERA POLYINVISAHIELD STRL", "code_information": [{"code": "DYNJE4250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE CHEST BREAST TIBURON 29420", "code_information": [{"code": "29420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE COVER MAYO STAND 8339", "code_information": [{"code": "8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE CRANIOTOMY 104IN X 100IN 18IN X 28ININCISE ABSORB REINFORCEMENT W/ 11IN X", "code_information": [{"code": "DYNJP10001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE EXTREMITY", "code_information": [{"code": "29414CE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE GENERAL ENDOSCOPY 9458", "code_information": [{"code": "9458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HIP 116IN X 88 X 131IN FENESTRATED ARM COVER", "code_information": [{"code": "89341", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HIP TIBURON W POUCHES 5 EA CS", "code_information": [{"code": "29439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IMPERVIOUS U-SPLIT 60 X 72IN", "code_information": [{"code": "8476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INCISE 36X17.5 INVISISHEILD DYNJSD1050Z", "code_information": [{"code": "DYNJSD1050Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INSTRUMENT PAD MD 10 X 16IN MAGNETIC", "code_information": [{"code": "80710CARD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IOBAN2 INCISE ANTIMCRBL 13X 1 6640EZ", "code_information": [{"code": "6640EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE IOBAN2 INCISEANTIMCRBL 23\"X33\" 6651EZ", "code_information": [{"code": "6651EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LEICA 117 X 305CM - 46X120 10/CS DR651", "code_information": [{"code": "DR651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 201.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LEICA/WILD SUB 54 X120", "code_information": [{"code": "54353UC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MCRSCP 54IN X 150IN W/ DRAWSTRING FOR LEICA LF STRL DISP", "code_information": [{"code": "AR8033650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICROSCOPE 65MM ZEISS", "code_information": [{"code": "4840-90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICROSCOPE LEICA", "code_information": [{"code": "P5450-UC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICROSCOPE LEICA 137X381CM DRAPETECH DR650", "code_information": [{"code": "DR650", "type": "CDM"}], "standard_charges": [{"gross_charge": 212.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICROSCOPE LEICA 54\" X 150\" DYNJE5330", "code_information": [{"code": "DYNJE5330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MINOR PROCEDURE 29496", "code_information": [{"code": "29496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE NAVIGATION TOUCHSCREEN 451611020", "code_information": [{"code": "451611020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9090.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE NEUROLOGICAL", "code_information": [{"code": "9448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ORTHO U 88X125 SPLIT 6X54 STERILE", "code_information": [{"code": "89311", "type": "CDM"}], "standard_charges": [{"gross_charge": 31.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE PATIENT ISOLATION W POUCH 5 EA BX", "code_information": [{"code": "D1017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ROBOTIC ASSIST STATION 451611018", "code_information": [{"code": "451611018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ROBOTIC ASSIST TOUCHSCREEN 451611019", "code_information": [{"code": "451611019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9090.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SPLIT IMPERVIOUS 60IN X 70IN", "code_information": [{"code": "K-C88660CS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SPLIT SHEET TIBURON 4X40", "code_information": [{"code": "29445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERI U-DRAPE 1015", "code_information": [{"code": "1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERI U-DRAPE SUB IS MMM1010Z 1010", "code_information": [{"code": "1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERIDRAPE ISOLATION W ACCESS 6617", "code_information": [{"code": "6617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 100IN X 77IN X 112 1/2IN BLUE ADHSV APERTURE FENESTRATED ARM COVER GU", "code_information": [{"code": "29493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 102IN X 121IN X 78IN LAP CHOLECYSTECTOMY W/ POUCHES PROXIMA LF", "code_information": [{"code": "DYNJP3102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.33, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 112IN X 137IN X 89IN HIP ABSORB REINFORCED FENESTRATED W/ POUCH STOP", "code_information": [{"code": "DYNJP8201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 13IN X 13ININCISE ANTIMICROBIAL W/ ADHSV LOBAN LF STRL", "code_information": [{"code": "6648EZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 15IN X 10IN CHEST BREAST PROXIMA FENESTRATED SMS LF DISP", "code_information": [{"code": "DYNJP2491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 31 X 51 MED ABSORB PREVENT FABRIC W/ ADHSV APERTURE AND POUCH STERI-D", "code_information": [{"code": "1030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 35.375 X 17.625 LGINCISE STERI-DRAPE LF STRL 1050", "code_information": [{"code": "1050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 41IN X 74IN CLR C ARM FULL SZINVISISHIELD LF STRL", "code_information": [{"code": "DYNJE4400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 77IN THREE QUARTER PP LF STRL DISP", "code_information": [{"code": "DYNJP2414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 54IN X 72IN IMPERVIOUS U DRP PROXIMA LF", "code_information": [{"code": "DYNJP2499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 76IN X 120IN BILATERAL LIMB REINFORCED CIRCULAR FENESTRATION TUBE HOL", "code_information": [{"code": "89291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.27, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 77IN X 120IN ORTHO SPLIT LF STRL DISP", "code_information": [{"code": "DYNJP8304A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 78IN X 102IN X 121IN LAPAROTOMY SHT 5 STRONG FIBER LAYER PLYPRPLN DRP", "code_information": [{"code": "DYNJP3003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG HIP W/ POUCHES ORTHOMAX", "code_information": [{"code": "DYNJP8211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG THYROID SOFT 5 STRONG FIBER LAYER PLYPRPLN DRPINCLUDES: ABSORB REINFO", "code_information": [{"code": "DYNJP7002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG VERTICAL ISOLATION PATIENT W/ POUCHESINVISISHIELD", "code_information": [{"code": "DYNJSD1017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG XL SHEET FAN FOLDED", "code_information": [{"code": "9444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.57, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURGICAL HIP E/ POUCH", "code_information": [{"code": "59439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.27, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURGICAL SPLIT IMPERV 60 X 81", "code_information": [{"code": "89333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE THYROID SHEET TIBURON 77 X 122.5 WITH ISO-BAC", "code_information": [{"code": "29422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE THYROID W  ARMBOARD COVERS 29522", "code_information": [{"code": "29522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TIBURON BILATERAL EXTRIMITY", "code_information": [{"code": "29417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL LARGE INVISISHIELD", "code_information": [{"code": "DYNJSD1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL STERILE LARGE 18 X 24 D1010", "code_information": [{"code": "D1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.66, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U PLASTIC 60X84 W ADHESIVE STRIP 8475", "code_information": [{"code": "8475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.03, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U SHAPE 80 X 124", "code_information": [{"code": "89532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UNIVERSAL C-ARM MOBILE XRAY 10 CS", "code_information": [{"code": "29-49519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE-STERI LARGE IOBAN 2 ISOLATION  6619", "code_information": [{"code": "6619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.54, "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": 14.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}], "standard_charges": [{"minimum": 40.1, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 281.39, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 281.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN M", "code_information": [{"code": "16025", "type": "CPT"}], "standard_charges": [{"minimum": 219.76, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 219.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN S", "code_information": [{"code": "16020", "type": "CPT"}], "standard_charges": [{"minimum": 122.58, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING  XEROFORM 5 X 9", "code_information": [{"code": "46-611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.71, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING ADHSV 6IN X 8IN TRANSPARENT FILM TEGADERM LF", "code_information": [{"code": "1628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AG AQUACEL SURGICAL 3.5X9.75 STERILE SILVER", "code_information": [{"code": "412011A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.61, "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": 31.55, "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": 31.55, "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": 31.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BORDER 4IN X 12IN POST OP MEPILEX", "code_information": [{"code": "295900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 52.32, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5 CM X 6 CM SURG AQUACEL", "code_information": [{"code": "412010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5IN X 3.75IN SURG AQUACEL LF", "code_information": [{"code": "412009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "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": 151.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FILM TRANSPARENT 4X10", "code_information": [{"code": "TD-27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FINE-MESH GAUZE 4 X 10 YD. ROLL  1 PLY QTX104360", "code_information": [{"code": "QTX104360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.66, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE 4IN X 10YD WHT FINE MESH", "code_information": [{"code": "898772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE 6IN X 6 3/4IN FLUFF BULKEE II LF STRL", "code_information": [{"code": "NON25853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE OIL EMULSION CURAD 3X3 CUR250330", "code_information": [{"code": "CUR250330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE PETROLATM CURAD 1X36 ST", "code_information": [{"code": "CUR251136", "type": "CDM"}], "standard_charges": [{"gross_charge": 2.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM CURAD 1X8 ST CUR253180", "code_information": [{"code": "CUR253180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.14, "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": 3.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING HEMOSTATIC SURGICEL SNOW 4X4CM", "code_information": [{"code": "2083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 674.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING IV TEGADERM ADVANCED 3.5X4.5", "code_information": [{"code": "1685", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEPILEX BORDER POST OP 4X8", "code_information": [{"code": "496405", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING OPTIFOAM AG POSTOPSTRIP 3.5X10 MSC96310", "code_information": [{"code": "MSC96310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PAD NON-ADHERANT 3 X 4IN TRAD", "code_information": [{"code": "C-DDS34S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PAD NON-ADHERANT 3 X 8IN TRAD", "code_information": [{"code": "C-DDS38S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PROTECTIVE DISK 1IN 7MM W/ CHG BIOPATCH", "code_information": [{"code": "ET 4152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TEGADERM+PAD 2 3 8X4 3584", "code_information": [{"code": "3584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TRANS FIRSTAID 4X4.75IN STER", "code_information": [{"code": "TD-21", "type": "CDM"}], "standard_charges": [{"gross_charge": 5.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TRNSPRNT FRAME 2.375X2.75 1634", "code_information": [{"code": "1634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TRNSPRNT SURGESITE 2.375 X 2.75", "code_information": [{"code": "MSC2302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 2 3/8IN X 2 3/4IN TRANSPARENT ADHSV COMFORMING PATIENT CARE W/ WIND", "code_information": [{"code": "1624W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 4IN X 10IN TRANSPARENT FILM ADHSV CONFORMING PATIENT CARE TEGADERM", "code_information": [{"code": "1627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 4IN X 4 3/4IN TRANSPARENT FILM ADHSV CONFORMING PATIENT CARE TEGADE", "code_information": [{"code": "1626W", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.61, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WND 4IN X 4 3/4IN TRANSPARENT FILM ADHSV ORIGINAL FRAME SET STYLE PATIE", "code_information": [{"code": "1626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 3IN X 4IN NON ADHERENT PRIMARY PAD TEFLA LF STRL", "code_information": [{"code": "1050 (TELFA)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 4IN X 10IN TRANSPARENT FILM CONFORMABLE SURESITE 123 LATEX FREE DISPOSABLE", "code_information": [{"code": "MSC2710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 4IN X 4IN EXTRA THIN DUODERM", "code_information": [{"code": "187955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND 5IN X 9IN STRIP PETROLATUM GAUZE ZEROFORM", "code_information": [{"code": "8884431605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING XEROFORM PETRO GAUZE ST 5X 9", "code_information": [{"code": "DKC20068", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSNG MEPILX AG 4X10 10X25CM POST-OP 395790", "code_information": [{"code": "395790", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.4MM FOR 3.5MM SCREW 202000335", "code_information": [{"code": "202000335", "type": "CDM"}], "standard_charges": [{"gross_charge": 544.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.4MM G3606010", "code_information": [{"code": "G3606010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3MM X 30 TWIST MR8-23TD3030", "code_information": [{"code": "MR8-23TD3030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 11 MM 7080510", "code_information": [{"code": "7080510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 809.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 12CM MATCH HEAD", "code_information": [{"code": "SD12MH25D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1384.71, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 12CM MATCH HEAD MR8-SD12MH25D", "code_information": [{"code": "MR8-SD12MH25D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1259.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 14CM MATCH HEAD", "code_information": [{"code": "SP14MH30D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2769.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 14CM MATCH HEAD MR8-SP14MH30D", "code_information": [{"code": "MR8-SP14MH30D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7559.24, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL MR8 14CM TAPER LONG 2.3MM DIAMETER MR8-14TA23L", "code_information": [{"code": "MR8-14TA23L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 774.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR DRAINAGE", "code_information": [{"code": "61108", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1184.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"minimum": 361.31, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL TOOL MR8 9CM ACORN 9MM DIAMETER MR8-9AC90", "code_information": [{"code": "MR8-9AC90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 3MM X 30MM MR8-31TD3030", "code_information": [{"code": "MR8-31TD3030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST AOSYNTH 0.126 X 4.92MM", "code_information": [{"code": "5604-54-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRN FLT SILICON 7MM X 20CM FUL PERF 0070430", "code_information": [{"code": "70430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.59, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG MASTISOL ADHSV LIQ LF VIAL", "code_information": [{"code": "F0523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRUG ADMIN & HEMODYNMIC MEAS", "code_information": [{"code": "93463", "type": "CPT"}], "standard_charges": [{"minimum": 131.68, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY 120+ RX&METABLT", "code_information": [{"code": "328U", "type": "CPT"}], "standard_charges": [{"minimum": 102.99, "maximum": 102.99, "discounted_cash": 148.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 102.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 102.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ADALIMUMAB", "code_information": [{"code": "80145", "type": "CPT"}], "standard_charges": [{"minimum": 34.71, "maximum": 584.01, "discounted_cash": 50.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY AMIODARONE", "code_information": [{"code": "80151", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CAFFEINE", "code_information": [{"code": "80155", "type": "CPT"}], "standard_charges": [{"minimum": 26.06, "maximum": 584.01, "discounted_cash": 50.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CLOZAPINE", "code_information": [{"code": "80159", "type": "CPT"}], "standard_charges": [{"minimum": 18.14, "maximum": 584.01, "discounted_cash": 26.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CYCLOSPORINE", "code_information": [{"code": "80158", "type": "CPT"}], "standard_charges": [{"minimum": 16.25, "maximum": 584.01, "discounted_cash": 23.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}], "standard_charges": [{"minimum": 12.36, "maximum": 584.01, "discounted_cash": 17.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 160.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FELBAMATE", "code_information": [{"code": "80167", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY INFLIXIMAB", "code_information": [{"code": "80230", "type": "CPT"}], "standard_charges": [{"minimum": 34.71, "maximum": 584.01, "discounted_cash": 50.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 52.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 34.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ITRACONAZOLE", "code_information": [{"code": "80189", "type": "CPT"}], "standard_charges": [{"minimum": 24.4, "maximum": 584.01, "discounted_cash": 35.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}], "standard_charges": [{"minimum": 24.4, "maximum": 584.01, "discounted_cash": 35.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.6, 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 1-3", "code_information": [{"code": "80375", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 4-6", "code_information": [{"code": "80376", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 7/MORE", "code_information": [{"code": "80377", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSPNG PIN MULTI ACCESS MINISPIKE MM412012", "code_information": [{"code": "MM412012", "type": "CDM"}], "standard_charges": [{"gross_charge": 15.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 272.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 320.25, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 373.81, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 373.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 184.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 234.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 317.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 364.13, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 364.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 472.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ EXTENSIVE RETINOPATHY", "code_information": [{"code": "67227", "type": "CPT"}], "standard_charges": [{"minimum": 399.51, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 399.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 279.27, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 279.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 192.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 129.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 269.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 308.18, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 308.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "420T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DT VACCINE UNDER 7 YRS IM", "code_information": [{"code": "90702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP VACCINE < 7 YRS IM", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-HEP B-IPV VACCINE IM", "code_information": [{"code": "90723", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV VACCINE 4-6 YRS IM", "code_information": [{"code": "90696", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV/HIB VACCINE IM", "code_information": [{"code": "90698", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUAL LAYER IMPAX, PER SQ CM", "code_information": [{"code": "Q4262", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2170.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 154.63, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 167.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 167.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 181.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 167.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL BI STD", "code_information": [{"code": "93985", "type": "CPT"}], "standard_charges": [{"minimum": 277.56, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL UNI STD", "code_information": [{"code": "93986", "type": "CPT"}], "standard_charges": [{"minimum": 164.09, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.09, "methodology": "fee schedule"}], "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": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1353.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DURASEAL DURAL  5ML SEALANT SYSTEM", "code_information": [{"code": "20-2050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4112.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"minimum": 106.87, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR EACH", "code_information": [{"code": "92623", "type": "CPT"}], "standard_charges": [{"minimum": 27.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 222.85, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 235.85, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 235.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 404.02, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 404.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 382.56, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 382.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/WASH", "code_information": [{"code": "31622", "type": "CPT"}], "standard_charges": [{"minimum": 375.84, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 25.22, "maximum": 584.01, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 93.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 400.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 400.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 537.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 445.22, "maximum": 4936.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 445.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 296.63, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 296.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPICAR CAR US CHD", "code_information": [{"code": "76987", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP THORACIC AORTA US", "code_information": [{"code": "76984", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY EXCL NB", "code_information": [{"code": "31525", "type": "CPT"}], "standard_charges": [{"minimum": 333.65, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY W/OPER SCOPE", "code_information": [{"code": "31526", "type": "CPT"}], "standard_charges": [{"minimum": 181.69, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR", "code_information": [{"code": "62270", "type": "CPT"}], "standard_charges": [{"minimum": 216.3, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"minimum": 287.0, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 147.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 147.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 159.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 147.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 147.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD UNI", "code_information": [{"code": "77065", "type": "CPT"}], "standard_charges": [{"minimum": 112.78, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 124.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY AXIAL", "code_information": [{"code": "77080", "type": "CPT"}], "standard_charges": [{"minimum": 39.22, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 49.67, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 20.24, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 199.5, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC FINE WIRE EMG", "code_information": [{"code": "96003", "type": "CPT"}], "standard_charges": [{"minimum": 34.16, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 24.86, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2975.7, "maximum": 6038.71, "discounted_cash": 6720.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3985.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3985.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6038.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5290.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3485.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2975.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3336.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYSPHAGIA SCREENING", "code_information": [{"code": "V5364", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Decalcification 88311", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "3927418", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 8.12, "maximum": 584.01, "gross_charge": 58.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Depakote", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "1099845", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.19, "maximum": 584.01, "gross_charge": 79.0, "discounted_cash": 17.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DermaBind FM, per square centimeter", "code_information": [{"code": "Q4313", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Dermacyte AC matrix amniotic membrane allograft, per square centimeter", "code_information": [{"code": "Q4343", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Destruction Of Growths In Uterus With Ultrasound Guidance Using An Endoscope", "code_information": [{"code": "404T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 898.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Diagnostic Hearing Loss Test", "code_information": [{"code": "92561", "type": "CPT"}], "standard_charges": [{"minimum": 67.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Dig or surv colsco", "code_information": [{"code": "G9937", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Digoxin Level", "code_information": [{"code": "80162", "type": "CPT"}, {"code": "633719", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.95, "maximum": 584.01, "gross_charge": 49.0, "discounted_cash": 17.26, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Direct Antiglobulin Test", "code_information": [{"code": "86880", "type": "CPT"}, {"code": "634331", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 4.85, "maximum": 584.01, "gross_charge": 5.0, "discounted_cash": 73.76, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.91, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 55.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 55.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Dual layer Amnio Burgeon X-Membrane, per square centimeter", "code_information": [{"code": "Q4366", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DuoAmnion, per square centimeter", "code_information": [{"code": "Q4327", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E COLI 0157 AG IA", "code_information": [{"code": "87335", "type": "CPT"}], "standard_charges": [{"minimum": 11.39, "maximum": 584.01, "discounted_cash": 16.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.39, "methodology": "fee 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"standard_charge_dollar": 1339.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1339.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1446.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1339.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR AND THROAT EXAMINATION", "code_information": [{"code": "92502", "type": "CPT"}], "standard_charges": [{"minimum": 117.87, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR CARTILAGE GRAFT", "code_information": [{"code": "21235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 980.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR MICROSCOPY EXAMINATION", "code_information": [{"code": "92504", "type": "CPT"}], "standard_charges": [{"minimum": 38.26, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"minimum": 76.3, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5555.54, "maximum": 18091.34, "discounted_cash": 11368.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11940.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11940.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18091.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15850.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10443.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8914.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5555.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [{"code": "146", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10238.57, "maximum": 42861.46, "discounted_cash": 18932.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28288.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28288.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42861.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37552.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24742.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21120.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10238.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3573.52, "maximum": 10603.18, "discounted_cash": 7127.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6998.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6998.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10603.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9289.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6120.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5224.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3573.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 93.5, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 167.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 167.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 181.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 167.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93225", "type": "CPT"}], "standard_charges": [{"minimum": 23.46, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93226", "type": "CPT"}], "standard_charges": [{"minimum": 45.35, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 67.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 67.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 73.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 45.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 24.69, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 224.36, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 180.64, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 305.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 305.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 330.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 305.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 180.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 32.96, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 26.97, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.9, "methodology": "fee 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"standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 51.48, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 56.71, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 56.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 56.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 61.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 56.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 56.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 72.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 5.08, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 233.9, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 252.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 150.08, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 150.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 150.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 150.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 150.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 266.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 288.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 266.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 265.54, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 438.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 438.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 473.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 438.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 265.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1060.19, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 981.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 981.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1060.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 981.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 209.61, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 209.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 155.51, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 217.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 217.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 235.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 217.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOGRAP TRANS R PROS STUDY", "code_information": [{"code": "76873", "type": "CPT"}], "standard_charges": [{"minimum": 114.03, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 114.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 114.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 123.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 114.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 114.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "3", "type": "MS-DRG"}], "standard_charges": [{"minimum": 95649.23, "maximum": 229560.28, "discounted_cash": 189782.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 151511.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 151511.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 229560.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 201125.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 132516.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 113120.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 95649.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 280.31, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 290.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 290.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"minimum": 407.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 407.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"minimum": 369.51, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 369.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 992.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"minimum": 510.41, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"minimum": 506.59, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"minimum": 568.78, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 568.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 567.38, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 567.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"minimum": 223.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"minimum": 223.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 283.38, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 283.38, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 562.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 562.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"minimum": 223.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 328.8, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 328.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"minimum": 283.61, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"minimum": 338.54, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"minimum": 146.13, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 209.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 209.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 226.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 209.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE", "code_information": [{"code": "20206", "type": "CPT"}, {"code": "1650441", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED CLOSED REDUCTION SHOULDER DISLOCATION W/ANESTHESIA 23655", "code_information": [{"code": "23655", "type": "CPT"}, {"code": "42587551", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 551.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "46550257", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 584.01, "gross_charge": 26.0, "discounted_cash": 12.14, "estimated_discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "1650391", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 29.46, "maximum": 584.01, "gross_charge": 49.0, "discounted_cash": 90.03, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED INTRAVENOUS INFUSION; HYDRATION - EACH ADDITIONAL HOUR 96361", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "46328274", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 17.29, "maximum": 584.01, "gross_charge": 172.0, 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"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": 149.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/VEEG", "code_information": [{"code": "95718", "type": "CPT"}], "standard_charges": [{"minimum": 187.92, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP EA INCR W/O VID", "code_information": [{"code": "95719", "type": "CPT"}], "standard_charges": [{"minimum": 225.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12 HR UNMNTR", "code_information": [{"code": "95705", "type": "CPT"}], "standard_charges": [{"minimum": 506.2, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12HR CONT MNTR", "code_information": [{"code": "95707", "type": "CPT"}], "standard_charges": [{"minimum": 506.2, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR CONT", "code_information": [{"code": "95710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR INTMT", "code_information": [{"code": "95709", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG WO VID 2-12HR INTMT MNTR", "code_information": [{"code": "95706", "type": "CPT"}], "standard_charges": [{"minimum": 506.2, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG WO VID EA 12-26HR UNMNTR", "code_information": [{"code": "95708", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 273.79, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 273.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BIOPSY SINGLE/MULTIPLE", "code_information": [{"code": "43239", "type": "CPT"}], "standard_charges": [{"minimum": 554.39, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 554.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 659.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD CONTROL BLEEDING ANY", "code_information": [{"code": "43255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD DIAGNOSTIC BRUSH WASH", "code_information": [{"code": "43235", "type": "CPT"}], "standard_charges": [{"minimum": 428.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 428.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD DILATE STRICTURE", "code_information": [{"code": "43245", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 864.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 321.72, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 260.32, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 510.79, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3508.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 671.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD GUIDE WIRE INSERTION", "code_information": [{"code": "43248", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 606.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 282.81, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 282.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD LESION ABLATION", "code_information": [{"code": "43270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1062.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 500.69, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 500.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43246", "type": "CPT"}], "standard_charges": [{"minimum": 239.5, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE FOREIGN BODY", "code_information": [{"code": "43247", "type": "CPT"}], "standard_charges": [{"minimum": 565.55, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 565.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE LESION SNARE", "code_information": [{"code": "43251", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 171.64, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 270.06, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 277.86, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 312.64, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [{"code": "43253", "type": "CPT"}], "standard_charges": [{"minimum": 312.9, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VARICES LIGATION", "code_information": [{"code": "43244", "type": "CPT"}], "standard_charges": [{"minimum": 292.77, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 292.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 277.63, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 464.02, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 464.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGFR GENE COM VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}], "standard_charges": [{"minimum": 292.12, "maximum": 584.01, "discounted_cash": 421.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 445.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 445.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 481.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 445.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 445.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA ANTIBODY", "code_information": [{"code": "86666", "type": "CPT"}], "standard_charges": [{"minimum": 9.16, "maximum": 584.01, "discounted_cash": 13.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.61, "maximum": 27.3, "discounted_cash": 25.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.52, "maximum": 33.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.51, "maximum": 11.51, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG RED DOT 3M ELECTRODE RESTING 2360", "code_information": [{"code": "2360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.71, "setting": "both", "billing_class": "facility"}]}, {"description": "EKG TRACING FOR INITIAL PREV", "code_information": [{"code": "G0404", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.01, "maximum": 15.68, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUAL/SEMIQ", "code_information": [{"code": "82656", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 14.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUANTITATIVE", "code_information": [{"code": "82653", "type": "CPT"}], "standard_charges": [{"minimum": 20.67, "maximum": 584.01, "discounted_cash": 29.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELASTIC WITH CONDYLAR PADSA AND JOINT KO  L1820", "code_information": [{"code": "L1820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 421.29, "setting": "both", "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY", "code_information": [{"code": "29830", "type": "CPT"}], "standard_charges": [{"minimum": 578.8, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 578.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29834", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 619.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29835", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29837", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 668.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29838", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 738.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW STANDARD W NIVO PORT", "code_information": [{"code": "73-1120969", "type": "CDM"}], "standard_charges": [{"gross_charge": 51.21, "setting": "both", "billing_class": "facility"}]}, {"description": "ELBOW STD F 4PT HEADGEAR MASK", "code_information": [{"code": "73-1072648", "type": "CDM"}], "standard_charges": [{"gross_charge": 52.69, "setting": "both", "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": 6.19, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS CPLX PRGRMG IINS", "code_information": [{"code": "590T", "type": "CPT"}], "standard_charges": [{"minimum": 226.86, "maximum": 245.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"minimum": 226.86, "maximum": 245.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.25, "maximum": 28.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.93, "maximum": 28.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"minimum": 218.79, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 87.88, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 87.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 87.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 94.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 87.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 8.58, "maximum": 4936.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 20.52, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 11.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 126.48, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 126.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 126.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 136.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 126.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 247.95, "maximum": 584.01, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE 6.5 MODIFIED BAYONET BLADE 0029M", "code_information": [{"code": "29M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.59, "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": 125.32, "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": 51.76, "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": 54.3, "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": 68.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6.5IN X 1IN EXTENDED BOVIE TIP SS", "code_information": [{"code": "E1551-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6IN COATEDINSULATED EDGE", "code_information": [{"code": "E14565-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.77, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE COATED NO-HEX E1450G", "code_information": [{"code": "E1450G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.77, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE INSULTE COATD SLEEVE 5.1 E1455B", "code_information": [{"code": "E1455B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CAUTERY X-LO 2.75 INCH", "code_information": [{"code": "E1475X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.82, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COATED 6 1/2ININSULATED COATED NDL STD PTFE FOR ALL VALLEYLAB PENCIL E", "code_information": [{"code": "E1465-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.61, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE CONFIGURATION TISSUE 45CM 5MM ENSEAL TRIO 3MM ETRIO345H", "code_information": [{"code": "ETRIO345H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1665.44, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE DEFIBRILLATOR 5.95IN X 5.24IN EDGE SYS ADLT", "code_information": [{"code": "11996-000017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.97, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG ADHES GEL SNAP CLOTH ADULT", "code_information": [{"code": "31043055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG RESTING TAB", "code_information": [{"code": "ERT100LC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.19, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ECG TAB 10 CARD 5000 CS  A MDSM616201", "code_information": [{"code": "MDSM616201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 740.77, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 10FTFT SWITCH BLD EDGE SS STRLINSTR DISP", "code_information": [{"code": "E2504H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.12, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 2.75IN COATED BLADE PTFEINSULATED HEXLOC EDGE STRL DIS", "code_information": [{"code": "E1455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 6.5IN 3/32IN STD PTFE COATED BLADE EDGE STRLINSTR DISP", "code_information": [{"code": "E1455-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.27, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ELECTROSURGICAL 90DEG GRAY ABLATION PROBE SUCT REPROCESS W/ SUCTION SA", "code_information": [{"code": "7210111R", "type": "CDM"}], "standard_charges": [{"gross_charge": 268.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 13 CM .093IN 15MM X 12MM ELECTROSURGICAL TUNGSTEN LLETZ STRL", "code_information": [{"code": "E1560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.63, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 2.84IN .093IN COATED ELECTROSURGICAL W/ SAFETY SLEEVE", "code_information": [{"code": "E1465B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.82, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 5.1MM COATED PTFEINSULATED CAUTERY EDGE", "code_information": [{"code": "E1465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NDL 6.5IN .06IN 2.3 MM EXTD STANDARD ELECTROSURGICAL DISP", "code_information": [{"code": "E15526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.93, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PENCIL BLADE SMOKE ATTACHMENT 10IN EDGE BUTTON SWITCH", "code_information": [{"code": "E2450HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.24, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE RESTING ECG LF", "code_information": [{"code": "45008-0000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.99, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 146.42, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 146.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 146.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 158.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 146.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}], "billing_class": 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BLUE NETWORK E", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY DX", "code_information": [{"code": "88348", "type": "CPT"}], "standard_charges": [{"minimum": 530.77, "maximum": 818.94, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 818.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIM.  PULSE GEN. COMPLEX SPINAL/PERIPH. NERVE W/PROGRAM 95972", "code_information": [{"code": "95972", "type": "CPT"}, {"code": "1618457", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 80.62, "maximum": 584.01, "gross_charge": 652.0, "discounted_cash": 118.87, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 205.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 205.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 221.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 205.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC ASSESSMENT OF PROGRAMMABLE PUMP FOR INTRATHECAL/EPIDURAL 62367", "code_information": [{"code": "62367", "type": "CPT"}, {"code": "1480680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 44.95, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 384.02, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93619", "type": "CPT"}], "standard_charges": [{"minimum": 553.92, "maximum": 6923.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 553.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 553.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 598.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 553.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 626.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 626.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 676.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 626.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5038.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 268.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 268.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 290.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 268.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 65.93, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS ST LOUIS ANTBODY", "code_information": [{"code": "86653", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS WEST EQNE ANTBDY", "code_information": [{"code": "86654", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 62.03, "maximum": 584.01, "discounted_cash": 89.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 109.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 109.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 118.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 109.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 109.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 401.76, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 423.28, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 423.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO RETRACT 10MM", "code_information": [{"code": "176613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.48, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "type": "CPT"}], "standard_charges": [{"minimum": 199.43, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE", "code_information": [{"code": "57505", "type": "CPT"}], "standard_charges": [{"minimum": 196.59, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4612.06, "maximum": 11686.49, "discounted_cash": 9164.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7713.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7713.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11686.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10238.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6746.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5758.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4612.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7396.53, "maximum": 16387.23, "discounted_cash": 14718.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10815.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10815.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16387.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14357.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9459.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8075.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7396.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3475.34, "maximum": 9503.36, "discounted_cash": 6869.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6272.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6272.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9503.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8326.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5485.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4682.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3475.34, "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": 121.3, "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": 154.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 496.84, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 496.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 629.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C EA", "code_information": [{"code": "92979", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOMETR ABLATE THERMAL", "code_information": [{"code": "58353", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1172.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION", "code_information": [{"code": "58356", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDONEEDLE SIZE 0 110CM 24MM TAPERCUT EC11", "code_information": [{"code": "EC11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCOPIC DECOMPRESSION OF SPINAL CORD INC. LAMINOTOMY PARTIAL FACETECTOMY  LUMBAR 62380", "code_information": [{"code": "62380", "type": "CPT"}, {"code": "44660575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 6671.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2668.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4002.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4336.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION/IMPLANT", "code_information": [{"code": "51715", "type": "CPT"}], "standard_charges": [{"minimum": 460.47, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 460.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 138.97, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 234.79, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 18.89, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY BOWEL POUCH/BIOP", "code_information": [{"code": "44386", "type": "CPT"}], "standard_charges": [{"minimum": 459.38, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 459.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [{"code": "31267", "type": "CPT"}], "standard_charges": [{"minimum": 301.93, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 301.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF BOWEL POUCH", "code_information": [{"code": "44385", "type": "CPT"}], "standard_charges": [{"minimum": 323.87, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 323.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 527.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 49.16, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 266.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 329.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 329.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 355.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 329.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 266.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"minimum": 237.34, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 237.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1257.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1684.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1414.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26736.94, "maximum": 123774.88, "discounted_cash": 54796.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81692.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81692.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 123774.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108443.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 71450.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 60992.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 26736.94, "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": 20997.08, "maximum": 92937.15, "discounted_cash": 42568.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61339.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61339.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92937.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81425.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53649.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 45796.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 20997.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2175.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 185.53, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1288.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 408.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1541.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 315.91, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1387.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 367.1, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENLARGED ORTHO SPLIT SHEET, TIBURON", "code_information": [{"code": "29440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.08, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 584.01, "discounted_cash": 20.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP AG IA", "code_information": [{"code": "87337", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"minimum": 284.52, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 284.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2977.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3424.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY", "code_information": [{"code": "86658", "type": "CPT"}], "standard_charges": [{"minimum": 11.73, "maximum": 584.01, "discounted_cash": 16.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY DFA", "code_information": [{"code": "87267", "type": "CPT"}], "standard_charges": [{"minimum": 12.08, "maximum": 584.01, "discounted_cash": 17.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS PROBE&REVRS TRNS", "code_information": [{"code": "87498", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTRADA NEEDLE COMPONENT FOR SPINAL CORD", "code_information": [{"code": "SC-4220-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "ENVERSE, PER SQ CM", "code_information": [{"code": "Q4258", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENVIRONMENTAL MANIPULATION", "code_information": [{"code": "90882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY", "code_information": [{"code": "82657", "type": "CPT"}], "standard_charges": [{"minimum": 19.95, "maximum": 584.01, "discounted_cash": 28.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY RA", "code_information": [{"code": "82658", "type": "CPT"}], "standard_charges": [{"minimum": 33.25, "maximum": 584.01, "discounted_cash": 57.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME HISTOCHEMISTRY", "code_information": [{"code": "88319", "type": "CPT"}], "standard_charges": [{"minimum": 69.74, "maximum": 584.01, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 139.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL BLOOD COUNT", "code_information": [{"code": "S3630", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPICORD 1 SQ CM", "code_information": [{"code": "Q4187", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"minimum": 216.5, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1144.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 159.73, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1187.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS MULT SESSIONS", "code_information": [{"code": "62263", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS ON SINGLE DAY", "code_information": [{"code": "62264", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 597.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDURAL TRAY SINGLE SHOT 20G X 3.5 TUOHY NEEDLE AND 7 ML 182A233", "code_information": [{"code": "182A233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.27, "setting": "both", "billing_class": "facility"}]}, {"description": "EPIEFFECT, PER SQ CM", "code_information": [{"code": "Q4278", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 1 SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3574.9, "discounted_cash": 3183.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3305.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3305.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3574.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3305.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3305.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1:1000 1MG/ML 1ML", "code_information": [{"code": "MED0076", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 30MG/30 ML", "code_information": [{"code": "MED0078", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 776.32, "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": 12.08, "setting": "both", "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 292.21, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 292.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6168.76, "maximum": 14220.62, "discounted_cash": 11905.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9385.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9385.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14220.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12459.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8209.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7007.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6168.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2978.42, "maximum": 6044.21, "discounted_cash": 6562.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3989.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3989.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6044.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5295.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3489.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2978.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3382.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR ANTIBODY", "code_information": [{"code": "86663", "type": "CPT"}], "standard_charges": [{"minimum": 11.81, "maximum": 584.01, "discounted_cash": 17.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR CAPSID VCA", "code_information": [{"code": "86665", "type": "CPT"}], "standard_charges": [{"minimum": 16.33, "maximum": 584.01, "discounted_cash": 23.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR NUCLEAR ANTIGEN", "code_information": [{"code": "86664", "type": "CPT"}], "standard_charges": [{"minimum": 13.76, "maximum": 584.01, "discounted_cash": 19.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 546.45, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 448.62, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 511.66, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 512.14, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 431.33, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 431.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 446.07, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 424.16, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 424.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 569.68, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 569.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "405U", "type": "CPT"}], "standard_charges": [{"minimum": 1593.43, "maximum": 1593.43, "discounted_cash": 2301.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 382.07, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 382.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 44.8, "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": 20.52, "setting": "both", "billing_class": "facility"}]}, {"description": "ESANO A, PER SQ CM", "code_information": [{"code": "Q4272", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO AAA, PER SQ CM", "code_information": [{"code": "Q4273", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO AC, PER SQ CM", "code_information": [{"code": "Q4274", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO ACA, PER SQ CM", "code_information": [{"code": "Q4275", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 96.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 633.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 633.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 684.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 633.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 689.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH EGD DILATION <30 MM", "code_information": [{"code": "43249", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1554.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH ENDOSCOPY DILATION", "code_information": [{"code": "43226", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1032.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1388.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 506.19, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 769.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 506.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCTION TEST", "code_information": [{"code": "91037", "type": "CPT"}], "standard_charges": [{"minimum": 177.83, "maximum": 1270.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 197.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 197.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 213.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 197.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 177.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 135.65, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 452.04, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 452.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 163.52, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 368.56, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/ESO EGD", "code_information": [{"code": "C9777", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 224.75, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 247.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 19.1, "maximum": 3347.0, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 39.08, "maximum": 3347.0, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 39.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 39.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL STETHOSCOPE 18FR. DYNJAES40018", "code_information": [{"code": "DYNJAES40018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPHAGEAL STETHOSCOPE W/400 SERIES 12FR DYNJAES40012", "code_information": [{"code": "DYNJAES40012", "type": "CDM"}], "standard_charges": [{"gross_charge": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4959.73, "maximum": 10064.97, "discounted_cash": 11340.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6642.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6642.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10064.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8818.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5810.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4959.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5732.72, "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": 3086.27, "maximum": 6263.07, "discounted_cash": 6970.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4133.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4133.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6263.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5487.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3615.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3086.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3482.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1633.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1677.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3531.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC DILATE BALLOON 30", "code_information": [{"code": "43214", "type": "CPT"}], "standard_charges": [{"minimum": 226.25, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 289.16, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 289.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 280.92, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 227.82, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 187.95, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1260.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX BIOPSY", "code_information": [{"code": "43202", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 261.03, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 261.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEXIBLE BRUSH", "code_information": [{"code": "43200", "type": "CPT"}], "standard_charges": [{"minimum": 378.37, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 378.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1032.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RETRO BALLOON", "code_information": [{"code": "43213", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1652.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 214.24, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 214.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO DX", "code_information": [{"code": "43191", "type": "CPT"}], "standard_charges": [{"minimum": 181.78, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 619.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 240.83, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE DILAT", "code_information": [{"code": "43196", "type": "CPT"}], "standard_charges": [{"minimum": 231.12, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 198.52, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 198.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 197.4, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 218.29, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 170.83, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS MOTILITY STUDY", "code_information": [{"code": "91010", "type": "CPT"}], "standard_charges": [{"minimum": 195.32, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 195.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 195.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 210.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 195.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 233.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 24.51, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4308.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4529.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3850.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4184.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESR", "code_information": [{"code": "85652", "type": "CPT"}, {"code": "1165918", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.43, "maximum": 584.01, "gross_charge": 26.0, "discounted_cash": 3.51, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 12-19", "code_information": [{"code": "90965", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 708.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 2-11", "code_information": [{"code": "90964", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 733.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 733.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 20+", "code_information": [{"code": "90966", "type": "CPT"}], "standard_charges": [{"minimum": 424.47, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 424.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO <2YRS", "code_information": [{"code": "90963", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 860.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 860.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"minimum": 293.65, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"minimum": 464.53, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 464.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1629.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1629.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1423.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1423.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"minimum": 502.48, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.48, "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": 584.01, "maximum": 712.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 712.25, "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": 584.01, "maximum": 739.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"minimum": 424.91, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 424.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"minimum": 510.57, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1094.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1094.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"minimum": 23.85, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"minimum": 24.34, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"minimum": 13.74, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"minimum": 25.25, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1992.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1204.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1290.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1722.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1235.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1310.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"minimum": 3881.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"minimum": 3881.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHIGUARD 0 VCRL PLS VIOLT 8-18 CTB2 CR VCPB727D", "code_information": [{"code": "VCPB727D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.31, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHIGUARD 1 VICRYL PLUS VIO 8-18 CTX VCPB765D", "code_information": [{"code": "VCPB765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.01, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHIGUARD 2-0 VICRL PLUS UNDYD 27 CTB-2 VCPB269H", "code_information": [{"code": "VCPB269H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.37, "setting": "both", "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}], "standard_charges": [{"minimum": 7.57, "maximum": 584.01, "discounted_cash": 10.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"minimum": 1748.82, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"minimum": 111.32, "maximum": 1100.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1799.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATE MOLE OF UTERUS", "code_information": [{"code": "59870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATION HEMATOMA 11740", "code_information": [{"code": "11740", "type": "CPT"}, {"code": "1480726", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 76.34, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 166.35, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVACUATOR 3 SPRING 400 CC DRAIN 1/4 0043620", "code_information": [{"code": "43620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.32, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR BULB 100CC 10MM FLAT DRAIN FULL PERFORATION PATTERN", "code_information": [{"code": "DC7144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.98, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR BULB 100CC 7 MM FLAT SILICONE", "code_information": [{"code": "71430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.98, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR BULB 100CC 7MM FLAT DRAIN FULL PERFORATION PATTERN", "code_information": [{"code": "DC7143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.98, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SILICONE 100CC STERILE 0070740", "code_information": [{"code": "70740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.56, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SILICONE 400CC BULB", "code_information": [{"code": "70400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.92, "setting": "both", "billing_class": "facility"}]}, {"description": "EVACUATOR SMOKE PENCIL", "code_information": [{"code": "CVPLP2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.41, "setting": "both", "billing_class": "facility"}]}, {"description": "EVAL AMNIOTIC FLUID PROTEIN", "code_information": [{"code": "84112", "type": "CPT"}], "standard_charges": [{"minimum": 88.3, "maximum": 584.01, "discounted_cash": 127.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 118.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 116.28, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 27.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 154.37, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 116.73, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 162.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 162.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 162.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 9.34, "maximum": 584.01, "discounted_cash": 13.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION HEART DEVICE", "code_information": [{"code": "93640", "type": "CPT"}], "standard_charges": [{"minimum": 511.9, "maximum": 3292.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 511.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 511.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 552.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 511.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 184.33, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 234.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 184.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94060", "type": "CPT"}], "standard_charges": [{"minimum": 43.16, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 85.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 85.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 85.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94070", "type": "CPT"}], "standard_charges": [{"minimum": 53.5, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 59.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 53.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 671.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"minimum": 286.93, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1460.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2125.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2681.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 519.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 519.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1619.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2637.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1375.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2153.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1455.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1113.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 886.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 55071.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVICEL SEALANT HEMOSTASIS 5.0 ML", "code_information": [{"code": "3905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1829.36, "setting": "both", "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 4.64, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TST COMPLETE", "code_information": [{"code": "92588", "type": "CPT"}], "standard_charges": [{"minimum": 6.39, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP < 5 CM", "code_information": [{"code": "24076", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 686.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 168.61, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 244.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 244.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 263.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 244.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 65.67, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 65.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXACTACAINE/CETACAINE TOPICAL ANESTHETIC SPRAY 56 GM", "code_information": [{"code": "MED0080", "type": "CDM"}], "standard_charges": [{"gross_charge": 236.6, "setting": "both", "billing_class": "facility"}]}, {"description": "EXAM FECES FOR MEAT FIBERS", "code_information": [{"code": "89160", "type": "CPT"}], "standard_charges": [{"minimum": 4.37, "maximum": 584.01, "discounted_cash": 6.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"minimum": 166.36, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "type": "CPT"}], "standard_charges": [{"minimum": 181.84, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM SYNOVIAL FLUID CRYSTALS", "code_information": [{"code": "89060", "type": "CPT"}], "standard_charges": [{"minimum": 6.6, "maximum": 584.01, "discounted_cash": 9.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "type": "CPT"}], "standard_charges": [{"minimum": 240.51, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "type": "CPT"}], "standard_charges": [{"minimum": 226.12, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC 3 CM/>", "code_information": [{"code": "22903", "type": "CPT"}], "standard_charges": [{"minimum": 561.69, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 561.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC < 3 CM", "code_information": [{"code": "22902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM 5 CM OR LESS", "code_information": [{"code": "49203", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 10 CM", "code_information": [{"code": "49205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 5 CM", "code_information": [{"code": "49204", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP 5 CM/>", "code_information": [{"code": "22901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 839.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [{"code": "22900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 717.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC 3 CM/>", "code_information": [{"code": "24071", "type": "CPT"}], "standard_charges": [{"minimum": 514.71, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC < 3 CM", "code_information": [{"code": "24075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 748.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC < 3 CM", "code_information": [{"code": "21930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 710.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP < 5 CM", "code_information": [{"code": "21932", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 823.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2188.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2003.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1453.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.5CM<", "code_information": [{"code": "11640", "type": "CPT"}], "standard_charges": [{"minimum": 268.88, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.6-1", "code_information": [{"code": "11641", "type": "CPT"}], "standard_charges": [{"minimum": 315.48, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 1.1-2", "code_information": [{"code": "11642", "type": "CPT"}], "standard_charges": [{"minimum": 355.61, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 2.1-3", "code_information": [{"code": "11643", "type": "CPT"}], "standard_charges": [{"minimum": 421.06, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 421.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 3.1-4", "code_information": [{"code": "11644", "type": "CPT"}], "standard_charges": [{"minimum": 522.39, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 522.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG >4 CM", "code_information": [{"code": "11646", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SBQ 2 CM/>", "code_information": [{"code": "21012", "type": "CPT"}], "standard_charges": [{"minimum": 427.39, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 427.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SC <2 CM", "code_information": [{"code": "21011", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 521.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.5 CM/<", "code_information": [{"code": "11440", "type": "CPT"}], "standard_charges": [{"minimum": 188.57, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 188.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.6-1 CM", "code_information": [{"code": "11441", "type": "CPT"}], "standard_charges": [{"minimum": 230.79, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 1.1-2 CM", "code_information": [{"code": "11442", "type": "CPT"}], "standard_charges": [{"minimum": 258.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 2.1-3 CM", "code_information": [{"code": "11443", "type": "CPT"}], "standard_charges": [{"minimum": 306.27, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 3.1-4 CM", "code_information": [{"code": "11444", "type": "CPT"}], "standard_charges": [{"minimum": 383.76, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 383.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [{"code": "11446", "type": "CPT"}], "standard_charges": [{"minimum": 530.64, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEEP <1.5CM", "code_information": [{"code": "28045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 649.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEP 1.5CM/>", "code_information": [{"code": "28041", "type": "CPT"}], "standard_charges": [{"minimum": 567.67, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 567.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC 1.5 CM/>", "code_information": [{"code": "28039", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 637.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC < 1.5 CM", "code_information": [{"code": "28043", "type": "CPT"}], "standard_charges": [{"minimum": 511.04, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC 3 CM/>", "code_information": [{"code": "25071", "type": "CPT"}], "standard_charges": [{"minimum": 532.93, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 532.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC < 3 CM", "code_information": [{"code": "25075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 726.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP 3 CM/>", "code_information": [{"code": "25073", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [{"code": "25076", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 649.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.5/<", "code_information": [{"code": "11420", "type": "CPT"}], "standard_charges": [{"minimum": 166.15, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}], "standard_charges": [{"minimum": 212.06, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 2.1-3", "code_information": [{"code": "11423", "type": "CPT"}], "standard_charges": [{"minimum": 277.6, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 3.1-4", "code_information": [{"code": "11424", "type": "CPT"}], "standard_charges": [{"minimum": 323.58, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 323.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP MAL+MARG 0.5/<", "code_information": [{"code": "11620", "type": "CPT"}], "standard_charges": [{"minimum": 263.74, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 263.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC 1.5 CM/>", "code_information": [{"code": "26111", "type": "CPT"}], "standard_charges": [{"minimum": 519.81, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 519.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC < 1.5 CM", "code_information": [{"code": "26115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 774.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP 1.5 CM/>", "code_information": [{"code": "26113", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 678.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP < 1.5 CM", "code_information": [{"code": "26116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 654.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HIP PELVIS LES SC 3 CM/>", "code_information": [{"code": "27043", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 594.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP < 5 CM", "code_information": [{"code": "27048", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 771.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELVIS LES SC < 3 CM", "code_information": [{"code": "27047", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 701.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE LES SC 3 CM/>", "code_information": [{"code": "27632", "type": "CPT"}], "standard_charges": [{"minimum": 518.69, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM < 3 CM", "code_information": [{"code": "27618", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 682.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEEP <5 CM", "code_information": [{"code": "27619", "type": "CPT"}], "standard_charges": [{"minimum": 581.08, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 581.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEP 5 CM/>", "code_information": [{"code": "27634", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP < 5 CM", "code_information": [{"code": "21556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 650.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1055.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL PART", "code_information": [{"code": "45171", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 809.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "type": "CPT"}], "standard_charges": [{"minimum": 304.06, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 1.1-2", "code_information": [{"code": "11622", "type": "CPT"}], "standard_charges": [{"minimum": 333.13, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 2.1-3", "code_information": [{"code": "11623", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 393.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 3.1-4", "code_information": [{"code": "11624", "type": "CPT"}], "standard_charges": [{"minimum": 451.69, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 451.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG >4 CM", "code_information": [{"code": "11626", "type": "CPT"}], "standard_charges": [{"minimum": 555.52, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC 3 CM/>", "code_information": [{"code": "23071", "type": "CPT"}], "standard_charges": [{"minimum": 534.39, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC < 3 CM", "code_information": [{"code": "23075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP 5 CM/>", "code_information": [{"code": "23073", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [{"code": "23076", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 688.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD", "code_information": [{"code": "15830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1411.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD ADD-ON", "code_information": [{"code": "15847", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 771.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U SMPL/NTRM", "code_information": [{"code": "11470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX COMPLEX", "code_information": [{"code": "11451", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 754.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX SMPL/NTRM", "code_information": [{"code": "11450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 605.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING COMPLEX", "code_information": [{"code": "11463", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING SMPL/NTRM", "code_information": [{"code": "11462", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 590.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC 3 CM/>", "code_information": [{"code": "27337", "type": "CPT"}], "standard_charges": [{"minimum": 535.34, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC < 3 CM", "code_information": [{"code": "27327", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEEP <5CM", "code_information": [{"code": "27328", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 776.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEP 5CM/>", "code_information": [{"code": "27339", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 938.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 3.1-4 CM", "code_information": [{"code": "11404", "type": "CPT"}], "standard_charges": [{"minimum": 305.55, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [{"code": "11600", "type": "CPT"}], "standard_charges": [{"minimum": 263.27, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 263.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.6-1 CM", "code_information": [{"code": "11601", "type": "CPT"}], "standard_charges": [{"minimum": 302.27, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 302.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [{"code": "11602", "type": "CPT"}], "standard_charges": [{"minimum": 320.35, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 2.1-3 CM", "code_information": [{"code": "11603", "type": "CPT"}], "standard_charges": [{"minimum": 368.21, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG >4 CM", "code_information": [{"code": "11606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 613.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. BENIGN LESION W/MARGINS 0.6CM TO 1.0CM 11422", "code_information": [{"code": "11422", "type": "CPT"}, {"code": "1587163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 238.97, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 238.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. BENIGN LESION W/MARGINS SCALP/NECK/FT/HD/GENT. OVER 4.0CM 11426", "code_information": [{"code": "11426", "type": "CPT"}, {"code": "1954774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 451.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC. CURETTAGE OF BONE CYST/BENIGN TUMOR OF FEMUR W/AUTOGRAFT INC. OBTAINING GRAFT 27357", "code_information": [{"code": "27357", "type": "CPT"}, {"code": "42915961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1011.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/B9 TUM RDS", "code_information": [{"code": "24120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM AGRF", "code_information": [{"code": "24115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 914.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM ALGR", "code_information": [{"code": "24116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1053.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS AGRF", "code_information": [{"code": "24125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 783.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS ALGR", "code_information": [{"code": "24126", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 814.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG B1 CST/B9 TUM HUM", "code_information": [{"code": "24110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 746.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 799.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE LENS PROSTHESIS", "code_information": [{"code": "66986", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1036.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 743.21, "methodology": "fee schedule"}], "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": 42.99, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 197.09, "maximum": 1100.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 312.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 312.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 337.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 312.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 197.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 183.65, "maximum": 1100.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 282.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 282.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 305.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 282.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"minimum": 234.3, "maximum": 1100.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 434.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 434.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 469.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 434.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 234.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1376.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ANAL EXT TAG/PAPILLA", "code_information": [{"code": "46220", "type": "CPT"}], "standard_charges": [{"minimum": 363.31, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 363.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1215.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN & TISSUE", "code_information": [{"code": "15839", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1238.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 795.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN ARM", "code_information": [{"code": "15836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 966.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1120.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1076.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1116.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28086", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28088", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 639.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2197.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INFERIOR TURBINATE", "code_information": [{"code": "30130", "type": "CPT"}], "standard_charges": [{"minimum": 521.51, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 521.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE LESION TESTIS", "code_information": [{"code": "54512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE LIP OR CHEEK FOLD", "code_information": [{"code": "40819", "type": "CPT"}], "standard_charges": [{"minimum": 368.85, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1450.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE MANDIBLE LESION", "code_information": [{"code": "21040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 639.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA B9 TUMOR", "code_information": [{"code": "21030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1740.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 483.47, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 483.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1234.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1377.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 980.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1562.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PHARYNX LESION", "code_information": [{"code": "42808", "type": "CPT"}], "standard_charges": [{"minimum": 311.11, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 311.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2642.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 627.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBMAXILLARY GLAND", "code_information": [{"code": "42440", "type": "CPT"}], "standard_charges": [{"minimum": 495.85, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 495.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE TENDON FOREARM/WRIST", "code_information": [{"code": "25109", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE WRIST TENDON SHEATH", "code_information": [{"code": "25118", "type": "CPT"}], "standard_charges": [{"minimum": 488.9, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40812", "type": "CPT"}], "standard_charges": [{"minimum": 373.56, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 373.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40814", "type": "CPT"}], "standard_charges": [{"minimum": 508.45, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 508.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 188.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 188.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 0.6CM -1.0CM 11401", "code_information": [{"code": "11401", "type": "CPT"}, {"code": "1480743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 205.76, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 1.1CM -2.0CM 11402", "code_information": [{"code": "11402", "type": "CPT"}, {"code": "1480744", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 227.12, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 885.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 2.1CM -3.0CM 11403", "code_information": [{"code": "11403", "type": "CPT"}, {"code": "1480745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 265.18, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 885.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 265.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION TRUNK 4.0CM OR MORE 11406", "code_information": [{"code": "11406", "type": "CPT"}, {"code": "1480747", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 440.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESIONTRUNK 0.5CM OR LESS 11400", "code_information": [{"code": "11400", "type": "CPT"}, {"code": "1480748", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 169.56, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 885.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BREAST LESION", "code_information": [{"code": "19125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION CONSTRICTING TISSUE", "code_information": [{"code": "26596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1043.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "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": 423.99, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 423.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2252.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 574.26, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 574.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1994.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1097.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42104", "type": "CPT"}], "standard_charges": [{"minimum": 289.63, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 289.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42106", "type": "CPT"}], "standard_charges": [{"minimum": 347.18, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 347.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA ARM SUBFASCIAL 5CM OR GREATER 24073", "code_information": [{"code": "24073", "type": "CPT"}, {"code": "1480791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK 3CM OR MORE 21931", "code_information": [{"code": "21931", "type": "CPT"}, {"code": "1480794", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4770.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1908.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2862.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3100.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 594.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA BACK 5CM OR MORE 21933", "code_information": [{"code": "21933", "type": "CPT"}, {"code": "1480795", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA NECK I 21552", "code_information": [{"code": "21552", "type": "CPT"}, {"code": "1480801", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 563.46, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LIPOMA NECK LESS THAN 3 CM 21555", "code_information": [{"code": "21555", "type": "CPT"}, {"code": "1480803", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 609.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ANAL LESION(S)", "code_information": [{"code": "46922", "type": "CPT"}], "standard_charges": [{"minimum": 453.09, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 453.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1635.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1894.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2415.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE FACIAL BONES 21026", "code_information": [{"code": "21026", "type": "CPT"}, {"code": "2025480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 7401.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 766.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE LOWER JAW", "code_information": [{"code": "21025", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1120.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1195.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BRAIN TUMOR", "code_information": [{"code": "61545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3878.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 748.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 503.45, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 503.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 757.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41825", "type": "CPT"}], "standard_charges": [{"minimum": 285.17, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41826", "type": "CPT"}], "standard_charges": [{"minimum": 398.7, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 398.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41827", "type": "CPT"}], "standard_charges": [{"minimum": 575.78, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 575.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 500.73, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 500.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MALIGNANT LESION TRUNK 3.1 CM TO 4.0CM 11604", "code_information": [{"code": "11604", "type": "CPT"}, {"code": "1480853", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 885.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1054.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40810", "type": "CPT"}], "standard_charges": [{"minimum": 285.86, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 542.8, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 542.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "41116", "type": "CPT"}], "standard_charges": [{"minimum": 444.34, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 444.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NAIL FOLD TOE", "code_information": [{"code": "11765", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 217.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42810", "type": "CPT"}], "standard_charges": [{"minimum": 512.59, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 639.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA CUTANEOUS NERVE 64788", "code_information": [{"code": "64788", "type": "CPT"}, {"code": "7209643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 515.9, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 515.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA MAJOR PERIPHERAL NERVE 64790", "code_information": [{"code": "64790", "type": "CPT"}, {"code": "1941670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1049.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENIS LESION(S)", "code_information": [{"code": "54060", "type": "CPT"}], "standard_charges": [{"minimum": 267.72, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 267.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1273.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1337.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1607.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 546.07, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY CYST", "code_information": [{"code": "42408", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2440.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2950.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2342.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2966.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1202.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1504.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE FOLD", "code_information": [{"code": "41115", "type": "CPT"}], "standard_charges": [{"minimum": 338.55, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41110", "type": "CPT"}], "standard_charges": [{"minimum": 300.17, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41112", "type": "CPT"}], "standard_charges": [{"minimum": 454.49, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 454.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 488.84, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41114", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 734.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL TAGS", "code_information": [{"code": "42860", "type": "CPT"}], "standard_charges": [{"minimum": 239.27, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TUMOR SOFT TISSUE NECK OR THORAX; 5 CM OR GREATER 21554", "code_information": [{"code": "21554", "type": "CPT"}, {"code": "1480802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 897.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UMBILICUS", "code_information": [{"code": "49250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UVULA", "code_information": [{"code": "42140", "type": "CPT"}], "standard_charges": [{"minimum": 402.88, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OLECRANON BURSA", "code_information": [{"code": "24105", "type": "CPT"}], "standard_charges": [{"minimum": 472.07, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION RADIAL HEAD", "code_information": [{"code": "24130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 641.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FACE/SCALP SUBFASCIAL LESS THAN 2CM 21013", "code_information": [{"code": "21013", "type": "CPT"}, {"code": "1480886", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 746.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT TISSUE FACE/SCALP SUBFASCIAL MORE THAN 2CM 21014", "code_information": [{"code": "21014", "type": "CPT"}, {"code": "1480887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1295.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"minimum": 153.79, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1042.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM W/ECG", "code_information": [{"code": "94617", "type": "CPT"}], "standard_charges": [{"minimum": 80.46, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM WO ECG", "code_information": [{"code": "94619", "type": "CPT"}], "standard_charges": [{"minimum": 59.18, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 89.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 89.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 96.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 89.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE W/HEMODYNAMIC MEAS", "code_information": [{"code": "93464", "type": "CPT"}], "standard_charges": [{"minimum": 177.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 177.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 63.74, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 63.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 59.18, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 53.05, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 53.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 3.22, "maximum": 584.01, "discounted_cash": 4.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 25.65, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOFIN TISSUE ADHESIVE 1 ML CHFEX7041001Z", "code_information": [{"code": "CHFEX7041001Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.86, "setting": "both", "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 288.0, "maximum": 584.01, "discounted_cash": 416.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 467.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6978.8, "discounted_cash": 6214.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6453.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6453.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6978.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6453.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6453.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 17520.0, "discounted_cash": 15600.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17520.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"minimum": 498.3, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 498.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"minimum": 511.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"minimum": 488.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 962.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 608.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31020", "type": "CPT"}], "standard_charges": [{"minimum": 573.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 573.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 867.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31256", "type": "CPT"}], "standard_charges": [{"minimum": 205.66, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "49000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 954.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1240.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ANKLE JOINT", "code_information": [{"code": "27612", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1314.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1017.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 748.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28022", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 663.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31070", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 588.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF HIP JOINT", "code_information": [{"code": "27033", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1179.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF MIDDLE EAR", "code_information": [{"code": "69440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 831.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1345.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINAL FUSION 22830", "code_information": [{"code": "22830", "type": "CPT"}, {"code": "1480921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1026.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF TOE JOINT", "code_information": [{"code": "28024", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF URETER", "code_information": [{"code": "50600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1136.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF VAGINA", "code_information": [{"code": "57000", "type": "CPT"}], "standard_charges": [{"minimum": 237.71, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 237.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 8094.23, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1131.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION SPHENOID SINUS", "code_information": [{"code": "31050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND 20100", "code_information": [{"code": "20100", "type": "CPT"}, {"code": "1480923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 674.32, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND ABDOMEN 20102", "code_information": [{"code": "20102", "type": "CPT"}, {"code": "1480924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2579.72, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 867.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1464.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2047.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1483.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2338.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23044", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 715.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1471.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1330.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1541.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1177.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2451.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 452.21, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 452.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1214.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69806", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1091.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1015.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 876.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2474.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1174.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1612.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE SCROTUM", "code_information": [{"code": "55110", "type": "CPT"}], "standard_charges": [{"minimum": 487.54, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 735.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1196.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND EXTREMITY", "code_information": [{"code": "20103", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 780.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1226.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1641.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1077.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1584.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1828.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 808.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27620", "type": "CPT"}], "standard_charges": [{"minimum": 578.75, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 578.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1174.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1140.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2028.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1633.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26075", "type": "CPT"}], "standard_charges": [{"minimum": 436.18, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 436.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26080", "type": "CPT"}], "standard_charges": [{"minimum": 512.79, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT HAND JOINT", "code_information": [{"code": "26070", "type": "CPT"}], "standard_charges": [{"minimum": 414.75, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT KNEE JOINT", "code_information": [{"code": "27331", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 606.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 693.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25101", "type": "CPT"}], "standard_charges": [{"minimum": 518.59, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67414", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1773.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 15.14, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 111.32, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 381.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"minimum": 15.14, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 34.41, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 223.9, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 223.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 223.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 241.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 223.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 48.85, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}], "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": 310.51, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION THORACIC LUMBAR SACRAL DME", "code_information": [{"code": "L1220", "type": "CDM"}], "standard_charges": [{"gross_charge": 2222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59111.13, "maximum": 119956.47, "discounted_cash": 190902.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 79172.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 79172.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119956.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 105098.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69246.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 59111.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 105874.86, "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": 18060.42, "maximum": 36650.69, "discounted_cash": 34819.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24189.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24189.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36650.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32110.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21157.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18060.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 19310.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1201.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1916.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1300.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1657.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2214.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1747.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1420.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1534.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2028.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "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": 10926.76, "maximum": 24745.34, "discounted_cash": 21982.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16332.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16332.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24745.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21680.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14284.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12193.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10926.76, "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": 21216.66, "maximum": 54817.74, "discounted_cash": 41951.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36180.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36180.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54817.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 48027.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31644.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 27012.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 21216.66, "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": 7445.18, "maximum": 15119.48, "discounted_cash": 15325.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9978.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9978.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15119.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13246.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8727.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7450.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7445.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1576.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1935.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2116.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1412.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1410.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1635.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1326.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1611.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4113.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1554.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1214.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1639.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2586.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 909.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE THYROID SURGERY", "code_information": [{"code": "60254", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1964.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1182.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1462.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1763.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1517.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1883.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1883.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 338.32, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"minimum": 26.97, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"minimum": 60.68, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL BILAT STUDY", "code_information": [{"code": "93880", "type": "CPT"}], "standard_charges": [{"minimum": 198.66, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 289.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 289.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 313.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 289.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7191.23, "maximum": 22647.55, "discounted_cash": 14508.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14947.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14947.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22647.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19842.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13073.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11160.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7191.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14821.18, "maximum": 31093.76, "discounted_cash": 29435.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20522.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20522.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31093.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27242.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17949.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15322.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14821.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5079.79, "maximum": 15357.61, "discounted_cash": 10510.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10136.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10136.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15357.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13455.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8865.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7567.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5079.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL UNI/LTD STUDY", "code_information": [{"code": "93882", "type": "CPT"}], "standard_charges": [{"minimum": 131.86, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 185.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 185.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 185.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 861.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 985.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION POUCHES / RETRIEVAL NETS EnTrap Polyp Retrieval Net 133-5543 30  230 2.8", "code_information": [{"code": "NT54511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.88, "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": 220.54, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR NAIL 3.25MM TRIGEN", "code_information": [{"code": "71631320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.68, "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": 12.53, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6832.85, "maximum": 15966.02, "discounted_cash": 13724.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10537.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10537.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15966.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13988.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9216.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7867.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6832.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21622.17, "maximum": 43878.69, "discounted_cash": 53142.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28960.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28960.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43878.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38443.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25329.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21622.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"code_information": [{"code": "931T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 1477.0, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Emboli detection without intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93897", "type": "CPT"}], "standard_charges": [{"minimum": 261.71, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 261.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Emergency Room Emtalaemergency Medical Screening Services", "code_information": [{"code": "451", "type": "RC"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Beyond Emtala Screening", "code_information": [{"code": "452", "type": "RC"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, General", "code_information": [{"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Other", "code_information": [{"code": "459", "type": "RC"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Urgent Care", "code_information": [{"code": "456", "type": "RC"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Enclose TL matrix, per square centimeter", "code_information": [{"code": "Q4351", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components", "code_information": [{"code": "C9901", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 1635.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Eosinophil Urine", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "633722", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.84, "maximum": 584.01, "gross_charge": 2.0, "discounted_cash": 5.55, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Epixpress, per square centimeter", "code_information": [{"code": "Q4361", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when perform", "code_information": [{"code": "884T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 1635.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99337", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 15 Minutes", "code_information": [{"code": "99334", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 25 Minutes", "code_information": [{"code": "99335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 40 Minutes", "code_information": [{"code": "99336", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ethanol Level", "code_information": [{"code": "80320", "type": "CPT"}, {"code": "633725", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "gross_charge": 62.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Examination Of Bladder And Urethra With Mechanical Dilation And Drug Delivery For Narrowing Of Urethra Using An Endoscope", "code_information": [{"code": "499T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 781.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 10.1 to 20 cm", "code_information": [{"code": "49188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2436.52, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 20.1 to 30 cm", "code_information": [{"code": "49189", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2824.11, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2824.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less", "code_information": [{"code": "49186", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1608.38, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1608.38, "methodology": "fee 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"Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); greater than 30 cm", "code_information": [{"code": "49190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3476.07, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3476.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EzPAP", "code_information": [{"code": "94667", "type": "CPT"}, {"code": "45497925", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 35.55, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 166.35, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F2 GENE", "code_information": [{"code": "81240", "type": "CPT"}], "standard_charges": [{"minimum": 59.12, "maximum": 584.01, "discounted_cash": 85.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 90.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 90.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 98.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 90.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 90.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 540.0, "maximum": 876.0, "discounted_cash": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 876.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACE BONE GRAFT", "code_information": [{"code": "21210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2377.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACE SHIELDLOW PROFILE SHORT LEN STERILE", "code_information": [{"code": "400-667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.08, "setting": "both", "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 99.82, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 139.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR TEST", "code_information": [{"code": "85335", "type": "CPT"}], "standard_charges": [{"minimum": 11.58, "maximum": 584.01, "discounted_cash": 16.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAM ADAPT BHV TX GDN PHY/QHP", "code_information": [{"code": "97156", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/O PT 50 MIN", "code_information": [{"code": "90846", "type": "CPT"}], "standard_charges": [{"minimum": 150.26, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/PT 50 MIN", "code_information": [{"code": "90847", "type": "CPT"}], "standard_charges": [{"minimum": 155.78, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FANCC GENE", "code_information": [{"code": "81242", "type": "CPT"}], "standard_charges": [{"minimum": 32.96, "maximum": 584.01, "discounted_cash": 47.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FASCIA LATA GRAFT BY STRIPPER 20920", "code_information": [{"code": "20920", "type": "CPT"}, {"code": "42593890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2579.72, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FATS/LIPIDS FECES QUAL", "code_information": [{"code": "82705", "type": "CPT"}], "standard_charges": [{"minimum": 4.59, "maximum": 584.01, "discounted_cash": 6.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FATS/LIPIDS FECES QUANT", "code_information": [{"code": "82710", "type": "CPT"}], "standard_charges": [{"minimum": 15.12, "maximum": 584.01, "discounted_cash": 21.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FCSD US ABLTJ LEIOMYOM>=200", "code_information": [{"code": "72T", "type": "CPT"}], "standard_charges": [{"minimum": 2829.0, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BILIRUBIN TEST", "code_information": [{"code": "82252", "type": "CPT"}], "standard_charges": [{"minimum": 4.1, "maximum": 584.01, "discounted_cash": 5.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BLOOD SCRN IMMUNOASSAY", "code_information": [{"code": "G0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.25, "maximum": 28.67, "discounted_cash": 23.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA PREP INSTIL", "code_information": [{"code": "G0455", "type": "HCPCS"}], "standard_charges": [{"minimum": 195.0, "maximum": 1100.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 234.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 234.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 252.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 234.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECES CULTURE AEROBIC BACT", "code_information": [{"code": "87045", "type": "CPT"}], "standard_charges": [{"minimum": 8.5, "maximum": 584.01, "discounted_cash": 12.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 54.58, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 306.67, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 394.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 394.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 426.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 394.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELT PLEDGET PTFE 4.8 MM X 9.5 MM IPR007963", "code_information": [{"code": "IPR007963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 10032.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5724.17, "maximum": 11616.28, "discounted_cash": 12404.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7666.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7666.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11616.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10177.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6705.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5724.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6079.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"minimum": 276.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENTANYL 250MCG/5ML AMP", "code_information": [{"code": "MED0461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.77, "maximum": 14.22, "discounted_cash": 12.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1160.7, "discounted_cash": 1033.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1073.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1073.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1160.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1073.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1073.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFIL W/O NST", "code_information": [{"code": "76819", "type": "CPT"}], "standard_charges": [{"minimum": 61.92, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 61.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 66.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 84.51, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 84.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1171.4, "discounted_cash": 986.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1171.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1171.4, "discounted_cash": 986.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1171.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1083.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 47.11, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 502.36, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"minimum": 46.94, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 27.4, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 594.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3074.73, "maximum": 6239.67, "discounted_cash": 7937.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4118.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4118.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6239.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5466.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3601.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3074.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4007.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION PRODUCTS", "code_information": [{"code": "85362", "type": "CPT"}], "standard_charges": [{"minimum": 6.2, "maximum": 584.01, "discounted_cash": 8.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADE SEMIQUANT", "code_information": [{"code": "85378", "type": "CPT"}], "standard_charges": [{"minimum": 8.75, "maximum": 584.01, "discounted_cash": 12.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.21, "methodology": "fee 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"standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ANTIGEN", "code_information": [{"code": "85385", "type": "CPT"}], "standard_charges": [{"minimum": 13.01, "maximum": 584.01, "discounted_cash": 18.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85366", "type": "CPT"}], "standard_charges": [{"minimum": 15.86, "maximum": 584.01, "discounted_cash": 104.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 72.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 72.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85370", "type": "CPT"}], "standard_charges": [{"minimum": 11.19, "maximum": 584.01, "discounted_cash": 16.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYSINS SCREEN I&R", "code_information": [{"code": "85390", "type": "CPT"}], "standard_charges": [{"minimum": 9.52, "maximum": 584.01, "discounted_cash": 20.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC ANTIPLASMIN", "code_information": [{"code": "85410", "type": "CPT"}], "standard_charges": [{"minimum": 6.94, "maximum": 584.01, "discounted_cash": 10.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMIN", "code_information": [{"code": "85400", "type": "CPT"}], "standard_charges": [{"minimum": 6.94, "maximum": 584.01, "discounted_cash": 10.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85415", "type": "CPT"}], "standard_charges": [{"minimum": 15.47, "maximum": 584.01, "discounted_cash": 22.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85420", "type": "CPT"}], "standard_charges": [{"minimum": 5.88, "maximum": 584.01, "discounted_cash": 8.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85421", "type": "CPT"}], "standard_charges": [{"minimum": 9.16, "maximum": 584.01, "discounted_cash": 13.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3013.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 833.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILTER BACTERIAL 22 MM X 15MM VIRAL LF", "code_information": [{"code": "1605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.38, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER FLUID TRAP RVFT10", "code_information": [{"code": "RVFT10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER RAPIDVAC ULPA", "code_information": [{"code": "SEA3700", "type": "CDM"}], "standard_charges": [{"gross_charge": 1139.97, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER TRANSFUSION", "code_information": [{"code": "SQ4OS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.54, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER TRANSFUSION 40UM RATED SQ40S", "code_information": [{"code": "SQ40S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.54, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"minimum": 40.53, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 966.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26497", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1158.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26498", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1476.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGERTIP TESTING CONTACT PLATE", "code_information": [{"code": "19374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.32, "setting": "both", "billing_class": "facility"}]}, {"description": "FISTULA REPAIR & COLOSTOMY", "code_information": [{"code": "57307", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1338.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR TRANSPERINE", "code_information": [{"code": "57308", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"minimum": 75.24, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 75.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 75.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 81.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 75.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"minimum": 87.78, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 87.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 87.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 87.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG C-LENS KERATOCONUS 1ST", "code_information": [{"code": "92072", "type": "CPT"}], "standard_charges": [{"minimum": 165.84, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 165.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"minimum": 24.18, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"minimum": 37.04, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 96.48, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 938.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIX LINK RETRAC ETHICON", "code_information": [{"code": "FLR01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 154.97, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION OF ANKLE JOINT", "code_information": [{"code": "27860", "type": "CPT"}], "standard_charges": [{"minimum": 206.65, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHOULDER BLADE", "code_information": [{"code": "23400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1185.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0163 6-7-8 8 180", "code_information": [{"code": "FW24015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0164 8-9-10 8 18", "code_information": [{"code": "FW24025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0165 10-11-12 8", "code_information": [{"code": "FW24035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0166 12-13.5-15", "code_information": [{"code": "FW24045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0167 15-16.5-18", "code_information": [{"code": "FW24055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXED WIRE ESOPHAGEAL MULTI-STAGE BALLOONS Rapide Esophageal Dilatation Balloon 129-0168 18-19-20 8", "code_information": [{"code": "FW24065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXHD/ALLOPATCHHD/SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW", "code_information": [{"code": "24330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 892.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOSEAL HEMOSTATIC MATRIX", "code_information": [{"code": "MED0082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 643.12, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 16 & >", "code_information": [{"code": "88189", "type": "CPT"}], "standard_charges": [{"minimum": 79.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 143.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 143.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 154.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 143.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 143.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 2-8", "code_information": [{"code": "88187", "type": "CPT"}], "standard_charges": [{"minimum": 35.41, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 35.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 35.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 9-15", "code_information": [{"code": "88188", "type": "CPT"}], "standard_charges": [{"minimum": 59.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 115.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 115.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 125.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 115.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 115.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 59.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 59.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWERAMNIOPATCH, PER SQ CM", "code_information": [{"code": "Q4178", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWERDERM, PER SQ CM", "code_information": [{"code": "Q4179", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE", "code_information": [{"code": "81245", "type": "CPT"}], "standard_charges": [{"minimum": 148.96, "maximum": 584.01, "discounted_cash": 215.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 223.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 223.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 242.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 223.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 223.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 148.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 148.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ANALYSIS", "code_information": [{"code": "81246", "type": "CPT"}], "standard_charges": [{"minimum": 74.7, "maximum": 584.01, "discounted_cash": 107.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 121.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 112.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ITD VARIANTS QUAN", "code_information": [{"code": "46U", "type": "CPT"}], "standard_charges": [{"minimum": 149.09, "maximum": 241.64, "discounted_cash": 529.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 223.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 223.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 241.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 223.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 223.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 149.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 149.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC PANDEM PRSRV FREE IM", "code_information": [{"code": "90666", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV3 NO PRESERV ID", "code_information": [{"code": "90654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV4 NO PRESERV ID", "code_information": [{"code": "90630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 366.15, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 366.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE 0.05%/15GM CREAM LIDEX", "code_information": [{"code": "MED0081", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.97, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 110.76, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "type": "CPT"}], "standard_charges": [{"minimum": 111.68, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 157.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN SODIUM OPHTHALMIC STRIPS/FUL-GLO", "code_information": [{"code": "MED0083", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.53, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 311.74, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 311.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 311.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 336.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 311.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 370.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY SCREEN", "code_information": [{"code": "86255", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY TITER", "code_information": [{"code": "86256", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORINE-18 FLUORODEOXYGLUCO", "code_information": [{"code": "S8085", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 17.02, "maximum": 584.01, "discounted_cash": 24.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROMETHOLONE 0.1% OPHTH 5ML DROPS", "code_information": [{"code": "MED0084", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 296.52, "setting": "both", "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 51.34, "maximum": 584.01, "discounted_cash": 74.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 40.4, "maximum": 584.01, "discounted_cash": 58.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 830.61, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 768.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 768.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 830.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 768.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 768.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY TECH", "code_information": [{"code": "70554", "type": "CPT"}], "standard_charges": [{"minimum": 366.61, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 423.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 423.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 458.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 423.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 423.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 366.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 546.66, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 311.52, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 311.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"minimum": 454.26, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 454.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 187.55, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN 1ST LES", "code_information": [{"code": "10021", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 70.7, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"minimum": 176.56, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 81.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM PEG 14IN", "code_information": [{"code": "105-14P", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 33.24, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 17.02, "maximum": 584.01, "discounted_cash": 24.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.02, "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": 11.26, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLDERS BLACK PRESENTATION", "code_information": [{"code": "BSN78490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.43, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLEYCATHETER SILCONE DYND11573 DYND11573", "code_information": [{"code": "DYND11573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.41, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 51.38, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 51.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP SURGERY OF EYE", "code_information": [{"code": "66250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1005.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOWUP EVAL OF FOOT PT LOP", "code_information": [{"code": "G0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.36, "maximum": 77.03, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7832.56, "maximum": 20476.81, "discounted_cash": 16713.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13514.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13514.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20476.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17940.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11820.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10090.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7832.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11811.78, "maximum": 25546.46, "discounted_cash": 24956.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16860.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16860.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25546.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22382.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14746.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12588.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11811.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6224.08, "maximum": 12630.76, "discounted_cash": 16030.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8336.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8336.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12630.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11066.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7291.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6224.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7832.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORCEPS 1590-01 STRT TIP BAYON BIPOLAR 1590-01", "code_information": [{"code": "1590-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2174.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPLR 7.5IN X 3IN BAYONETINSULATED STRAIGHT SMOOTH TIP TWIN PIN CONNECTO", "code_information": [{"code": "20-1380I", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 7 1/2 BAYONET NON INSULATED", "code_information": [{"code": "20-1380K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.57, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 7.5IN X 3IN INSULATED KIT", "code_information": [{"code": "20-1380KI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1497.91, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 7.75IN BAYONET SCOVILLE DISP", "code_information": [{"code": "19-1003C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.89, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 7.75MM BAYONET SCOVILLE", "code_information": [{"code": "19-1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.31, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 8.5MM BAYONET HARDY DISP", "code_information": [{"code": "19-1229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.68, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR MACRO ENDOPATH EBF01", "code_information": [{"code": "EBF01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BX SPK ALGTR JW 1 DRV WRE HNG LNKG 230CM JMB DISP (Single Pack Number is BF41080)", "code_information": [{"code": "BF40181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MAGILL INTUBATION 8 MDS0419020F", "code_information": [{"code": "MDS0419020F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1528.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 518.07, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 518.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 518.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 10.68, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FR FRZ PLASMA DONOR RETESTED", "code_information": [{"code": "P9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.06, "maximum": 131.82, "discounted_cash": 65.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 131.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 25.65, "maximum": 584.01, "discounted_cash": 37.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 48.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 48.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 48.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 48.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE ASSESSMENT VIA DXA", "code_information": [{"code": "77086", "type": "CPT"}], "standard_charges": [{"minimum": 32.33, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE KIT KYPHON II 10/2 EXPRESS 2", "code_information": [{"code": "KEX102EB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11120.91, "setting": "both", "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [{"code": "562", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6531.6, "maximum": 21695.02, "discounted_cash": 12739.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14318.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14318.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21695.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19007.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12523.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10690.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6531.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [{"code": "563", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3989.03, "maximum": 11620.41, "discounted_cash": 8006.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7669.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7669.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11620.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10181.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6708.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5726.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3989.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6805.63, "maximum": 35472.4, "discounted_cash": 14017.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23412.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23412.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35472.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31078.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20476.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17479.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6805.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3632.88, "maximum": 16921.31, "discounted_cash": 7207.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11168.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11168.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16921.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14825.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9768.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8338.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3632.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5935.34, "maximum": 27655.26, "discounted_cash": 11462.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18252.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18252.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27655.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24229.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15964.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13627.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5935.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3619.05, "maximum": 17078.24, "discounted_cash": 7221.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11271.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11271.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17078.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14962.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9858.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8415.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3619.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNEY STONE", "code_information": [{"code": "50590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1016.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENSIS", "code_information": [{"code": "86668", "type": "CPT"}], "standard_charges": [{"minimum": 12.74, "maximum": 584.01, "discounted_cash": 18.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE ASSAY (FT-3)", "code_information": [{"code": "84481", "type": "CPT"}], "standard_charges": [{"minimum": 15.25, "maximum": 584.01, "discounted_cash": 22.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2599.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2624.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2606.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2007.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1335.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}], "standard_charges": [{"minimum": 248.59, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 30.09, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 99.45, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 107.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 74.7, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 80.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 10.88, "maximum": 584.01, "discounted_cash": 15.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN PLASMA, POOLED, SD", "code_information": [{"code": "P9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.2, "maximum": 154.66, "discounted_cash": 68.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 143.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 143.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 154.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 143.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GR F/C/C/M/N/AX/G/H/F EA", "code_information": [{"code": "15241", "type": "CPT"}], "standard_charges": [{"minimum": 238.28, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 238.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GR FR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "15240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1249.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L 20 SQCM/<", "code_information": [{"code": "15260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1338.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 276.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L 20 SQ CM/<", "code_information": [{"code": "15220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1040.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L EACH ADDL", "code_information": [{"code": "15221", "type": "CPT"}], "standard_charges": [{"minimum": 177.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 177.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK 20 SQ CM/<", "code_information": [{"code": "15200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1160.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 195.92, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUP DNA SEQ CMPR ALYS", "code_information": [{"code": "341U", "type": "CPT"}], "standard_charges": [{"minimum": 1710.18, "maximum": 1710.18, "discounted_cash": 2470.26, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 683.15, "maximum": 683.15, "discounted_cash": 986.77, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"minimum": 715.5, "maximum": 715.5, "discounted_cash": 1033.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2171.56, "discounted_cash": 1933.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2007.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2007.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2171.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2007.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2007.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 62.57, "maximum": 584.01, "discounted_cash": 90.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 138.15, "maximum": 584.01, "discounted_cash": 199.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 207.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 207.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 224.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 207.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 207.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 49.99, "maximum": 584.01, "discounted_cash": 72.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 74.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 48.87, "maximum": 584.01, "discounted_cash": 70.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 79.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 116.1, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 176.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 176.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 176.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 50.63, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4224.45, "maximum": 18612.94, "discounted_cash": 37281.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5658.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5658.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8572.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7510.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4948.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4224.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18612.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27183.55, "maximum": 55164.61, "discounted_cash": 64133.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36409.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36409.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55164.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 48331.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31844.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 27183.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 29807.93, "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": 8216.25, "maximum": 16673.54, "discounted_cash": 28798.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11004.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11004.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16673.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14608.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9624.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8216.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14194.13, "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": 9576.71, "maximum": 20257.95, "discounted_cash": 19765.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13370.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13370.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20257.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17748.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11694.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9982.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9576.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL BRAIN MAPPING", "code_information": [{"code": "96020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"minimum": 21.72, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION MOLD", "code_information": [{"code": "87107", "type": "CPT"}], "standard_charges": [{"minimum": 9.29, "maximum": 584.01, "discounted_cash": 13.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS NES ANTIBODY", "code_information": [{"code": "86671", "type": "CPT"}], "standard_charges": [{"minimum": 11.03, "maximum": 584.01, "discounted_cash": 15.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2718.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2984.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3884.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1684.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1749.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1705.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1430.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1805.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE HAND BONES WITH GRAFT", "code_information": [{"code": "25825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3640.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2030.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1348.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1591.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1663.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 254.93, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF ANKLE JOINT OPEN", "code_information": [{"code": "27870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1233.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1380.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28755", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1219.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1030.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1494.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1164.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JNT ADD-ON", "code_information": [{"code": "26861", "type": "CPT"}], "standard_charges": [{"minimum": 114.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINT", "code_information": [{"code": "26860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 800.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26471", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 850.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26474", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 861.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1481.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND BONES", "code_information": [{"code": "25820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND JOINT", "code_information": [{"code": "26843", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1012.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1787.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE", "code_information": [{"code": "26850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 933.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINT", "code_information": [{"code": "26516", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 947.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26517", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1113.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1126.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE WITH GRAFT", "code_information": [{"code": "26852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1051.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3155.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 979.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1285.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1246.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1644.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1604.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF THUMB", "code_information": [{"code": "26841", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 990.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TIBIOFIBULAR JOINT", "code_information": [{"code": "27871", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 856.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TOES", "code_information": [{"code": "28280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 666.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1733.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1504.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1393.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1372.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF WRIST JOINT", "code_information": [{"code": "25800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 891.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION RADIOULNAR JNT/ULNA", "code_information": [{"code": "25830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1281.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE CERVICAL POSTERIOR AND DISCECTOMY 22600", "code_information": [{"code": "22600", "type": "CPT"}, {"code": "1480966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 6771.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1647.25, "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": 584.01, "maximum": 14280.0, "gross_charge": 6771.0, "discounted_cash": 21922.55, "estimated_discounted_cash": 24370.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1905.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE LUMBAR TRANSFORAMINAL INTERBODY 22630", "code_information": [{"code": "22630", "type": "CPT"}, {"code": "1480970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 14280.0, "gross_charge": 6771.0, "discounted_cash": 33925.68, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1933.19, "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": 584.01, "maximum": 4936.0, "gross_charge": 6771.0, "discounted_cash": 21922.55, "estimated_discounted_cash": 6771.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1616.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1222.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF FINGER JOINT", "code_information": [{"code": "26862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF HAND JOINT", "code_information": [{"code": "26844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1107.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1044.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1052.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "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"}, 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"standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA AMP PROBE", "code_information": [{"code": "87511", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA DIR PROBE", "code_information": [{"code": "87510", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA QUANT", "code_information": [{"code": "87512", "type": "CPT"}], "standard_charges": [{"minimum": 37.58, "maximum": 584.01, "discounted_cash": 54.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAS SAMPLING LINE M M 50EA CS WHSA30MM", "code_information": [{"code": "WHSA30MM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.47, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTRIC ANALY W/PH EA SPEC", "code_information": [{"code": "82930", "type": "CPT"}], "standard_charges": [{"minimum": 6.04, "maximum": 584.01, "discounted_cash": 8.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2016.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2200.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78264", "type": "CPT"}], "standard_charges": [{"minimum": 307.37, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 307.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 307.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 332.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 307.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 307.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 396.46, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 444.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 444.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 480.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 444.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 444.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 396.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 454.5, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 532.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 532.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 575.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 532.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 532.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MOTILITY STUDIES", "code_information": [{"code": "91020", "type": "CPT"}], "standard_charges": [{"minimum": 284.74, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 284.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 284.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 307.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 284.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 205.5, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 269.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 269.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 291.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 269.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 269.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 15.92, "maximum": 584.01, "discounted_cash": 23.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 243.58, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 243.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX TEST", "code_information": [{"code": "91034", "type": "CPT"}], "standard_charges": [{"minimum": 199.28, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4400.07, "maximum": 9400.12, "discounted_cash": 8768.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6204.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6204.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9400.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8235.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5426.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4632.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4400.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7710.91, "maximum": 15648.05, "discounted_cash": 16344.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10327.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10327.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15648.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13709.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9033.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7710.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8114.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2841.59, "maximum": 7382.17, "discounted_cash": 5636.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4872.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4872.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7382.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6467.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4261.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3637.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2841.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3577.54, "maximum": 9643.76, "discounted_cash": 7061.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6364.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6364.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9643.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8449.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5566.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4752.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3577.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6560.16, "maximum": 19315.05, "discounted_cash": 13204.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12748.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12748.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19315.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16922.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11149.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9517.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6560.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2442.15, "maximum": 6633.35, "discounted_cash": 4864.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4378.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4378.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6633.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5811.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3829.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3268.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2442.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2775.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3268.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2383.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1573.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 260.48, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 271.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 271.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 293.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 271.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 271.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 212.94, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 225.29, 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"standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 55.37, "maximum": 584.01, "discounted_cash": 79.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 55.37, "methodology": "fee 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SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GL0VE 6.0 PROT HYDRO LTX PF SURG", "code_information": [{"code": "2D72LS60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.18, "setting": "both", "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0117", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.07, "maximum": 111.09, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 111.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0118", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.97, "maximum": 88.6, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1028.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1027.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1147.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1269.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIDESHEETS IOL 5 X 35MM 2.5MM RADIUS", "code_information": [{"code": "9204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.49, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  BIOGEL PI ORTHO PRO SIZE 7.0 47670", "code_information": [{"code": "47670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  BIOGEL PI ORTHO PRO SIZE 7.5 47675", "code_information": [{"code": "47675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.94, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  BIOGEL PI ORTHO PRO SIZE 8.5 47685", "code_information": [{"code": "47685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  SURGICAL BIOGEL PI IND SZ 6.5 41665", "code_information": [{"code": "41665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.84, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  SURGICAL BIOGEL PI IND SZ 7.5 41675", "code_information": [{"code": "41675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.29, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  SURGICAL BIOGEL PI IND SZ 8.0 41680", "code_information": [{"code": "41680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.84, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE  SURGICAL BIOGEL PI IND SZ 9.0 41690", "code_information": [{"code": "41690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.86, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 6.5 42665", "code_information": [{"code": "42665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 7.0 42670", "code_information": [{"code": "42670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 7.5 42675", "code_information": [{"code": "42675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRA TOUCH M SZ 8.5 42685", "code_information": [{"code": "42685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRATOUCH G 7.0 LF 42170", "code_information": [{"code": "42170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRATOUCH G 8.5 LF 42185", "code_information": [{"code": "42185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PI ULTRATOUCH M 8.0 LF", "code_information": [{"code": "42680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.79, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE BIOGEL PLULTRATOUCHG SZ 6.5 LF 42165", "code_information": [{"code": "42165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE CHEMOTHERAPY MED SAFETY", "code_information": [{"code": "BS0460-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.73, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE EXAM LG 15ML SAFETY PF", "code_information": [{"code": "BS0470-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.73, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE EXAM PF THIN NTRL FINGER TEX L 88TN04L", "code_information": [{"code": "88TN04L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE NITRILE ESTM STRTCHY BLUE S 8855NSB", "code_information": [{"code": "8855NSB", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.57, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE NITRILE ESTM STRTCHY TL BLUE L 8857NLB", "code_information": [{"code": "8857NLB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.57, "setting": "both", "billing_class": 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"facility"}]}, {"description": "GOWN SURG EXTRA XL EXTRA LNG BLUE REINFORCED HOOK AND LOOP CLOSURE POLYETHYLENE", "code_information": [{"code": "DYNJP2206S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.21, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG LG 43IN BLUE NON REINFORCED SETIN SLEEVES HOOK AND LOOP CLOSURE AURORA", "code_information": [{"code": "DYNJP2701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.89, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG LG NON REINFORCED HOOK AND LOOP CLOSURE SMS FABRIC W/ SETIN SLEEVE SIR", "code_information": [{"code": "DYNJP2001S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.82, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL 47IN BLUE IMPERVIOUS HOOK AND LOOP CLOSURE AAMI LEVEL 4 PREVENT PLU", "code_information": [{"code": "DYNJP2307P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.73, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL 47IN BLUE NON REINFORCED SETIN SLEEVE HOOK AND LOOP CLOSURE AURORA", "code_information": [{"code": "DYNJP2702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.14, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURG XL NON REINFORCED HOOK AND LOOP CLOSURE SMS FABRIC W/ SETIN SLEEVE SIR", "code_information": [{"code": "DYNJP2002S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.92, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURGICAL FABRIC-REINFORCED LRGE 9511", "code_information": [{"code": "9511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.79, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN SURGICAL LEVEL 3 BL 4XL STERILE", "code_information": [{"code": "9599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.49, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN WARMING STANDARD 51IN FLEX CLINICAL OR COMFORT WARMING 2INSERTS BAIR PAWS", "code_information": [{"code": "81003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.44, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN WARMING XL 51IN ONE HOSE PORT FOR COMFORT WARMING ONE HOSE PORT FOR CLINICA", "code_information": [{"code": "81201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.38, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN WITH ELASTIC WRISTS STERILE YELLOW SIZE L LIGHTWEIGHT MULTILAYER COVER  NON275670", "code_information": [{"code": "NON275670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.11, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN XL LONG SMART SURGICAL", "code_information": [{"code": "32474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.11, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN XLG STRL BACK BREATHABL IMPERV 9041", "code_information": [{"code": "9041", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN XXLG SMART IMP STERILE 89075", "code_information": [{"code": "89075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.19, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFIX CORE, GRAFIXPL CORE", "code_information": [{"code": "Q4132", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIX PLUS, PER SQ CM", "code_information": [{"code": "Q4304", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIX STRAVIX PRIME PL SQCM", "code_information": [{"code": "Q4133", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE MAJOR 20902", "code_information": [{"code": "20902", "type": "CPT"}, {"code": "1480992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 321.7, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE MINOR 20900", "code_information": [{"code": "20900", "type": "CPT"}, {"code": "1480995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 526.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE SPINE 20930", "code_information": [{"code": "20930", "type": "CPT"}, {"code": "1480996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8663.0, "gross_charge": 4737.0, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8663.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE SPINE W/HARVEST 20936", "code_information": [{"code": "20936", "type": "CPT"}, {"code": "1480997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8663.0, "gross_charge": 4737.0, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8663.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BP SUTURABLE 4CM X 5CM BP10405", "code_information": [{"code": "BP10405", "type": "CDM"}], "standard_charges": [{"gross_charge": 1782.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1181.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET", "code_information": [{"code": "Q4107", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANULOCYTES, PHERESIS UNIT", "code_information": [{"code": "P9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 3774.34, "maximum": 4076.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3774.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3774.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4076.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3774.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRASPER BABCOCK 5MM 33CM", "code_information": [{"code": "5BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.81, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER ENDO 33 CM 10MM RATCHET HANDLE ANVIL ENDOPATH STRL DISP", "code_information": [{"code": "10AG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER ENDOPATH 5 MM -ORDR QTY 6 5DSG", "code_information": [{"code": "5DSG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER LAPSCR ROT", "code_information": [{"code": "174233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 940.69, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Alligator Rat Tooth 131-2209 Alligator-Rat Blue 230 2.8", "code_information": [{"code": "GF61061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Alligator Tooth 131-2208 Alligator Blue 230 2.8", "code_information": [{"code": "GF61041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS Grasping Forceps Blue Rat Tooth 131-2207 Rat Blue 230 2.8", "code_information": [{"code": "GF61021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3926.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 875.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"minimum": 272.32, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 272.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP BEHAVE COUNS 2-10", "code_information": [{"code": "G0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.46, "maximum": 17.46, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP CAREGIVER TRAINING", "code_information": [{"code": "97552", "type": "CPT"}], "standard_charges": [{"minimum": 29.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP HEALTH EDUCATION", "code_information": [{"code": "99078", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP MNT 2 OR MORE 30 MINS", "code_information": [{"code": "G0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.25, "maximum": 33.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP PSYCHOTHERAPY", "code_information": [{"code": "90853", "type": "CPT"}], "standard_charges": [{"minimum": 42.6, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROUP THERAPEUTIC PROCEDURES", "code_information": [{"code": "97150", "type": "CPT"}], "standard_charges": [{"minimum": 24.73, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE ANTIBODY", "code_information": [{"code": "86277", "type": "CPT"}], "standard_charges": [{"minimum": 14.17, "maximum": 584.01, "discounted_cash": 20.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80428", "type": "CPT"}], "standard_charges": [{"minimum": 60.03, "maximum": 584.01, "discounted_cash": 86.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 132.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 122.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 60.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 60.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80430", "type": "CPT"}], "standard_charges": [{"minimum": 116.4, "maximum": 584.01, "discounted_cash": 168.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 156.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH STIMULATION GENE 2", "code_information": [{"code": "83006", "type": "CPT"}], "standard_charges": [{"minimum": 40.41, "maximum": 584.01, "discounted_cash": 98.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY PHY/QHP", "code_information": [{"code": "97158", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY TECH", "code_information": [{"code": "97154", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GSTR EMPTG 7 TIMED BRTH SPEC", "code_information": [{"code": "106U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 787.04, "discounted_cash": 1136.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 787.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 787.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GTT-ADDED SAMPLES", "code_information": [{"code": "82952", "type": "CPT"}], "standard_charges": [{"minimum": 3.53, "maximum": 584.01, "discounted_cash": 5.1, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, an", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 124.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 60.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 60.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BREATH", "code_information": [{"code": "83013", "type": "CPT"}], "standard_charges": [{"minimum": 60.62, "maximum": 584.01, "discounted_cash": 87.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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COMPASS", "standard_charge_dollar": 60.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI AG IA", "code_information": [{"code": "87339", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 584.01, "discounted_cash": 20.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI DRUG ADMIN", "code_information": [{"code": "83014", "type": "CPT"}], "standard_charges": [{"minimum": 7.07, "maximum": 584.01, "discounted_cash": 10.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 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SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALTER HEAD MED TRACTION DELUXE NO SPREAD BAR", "code_information": [{"code": "6101-02", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 97.05, "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": 6719.49, "maximum": 15672.83, "discounted_cash": 14076.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10344.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10344.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15672.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13731.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9047.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7723.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6719.49, "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": 4550.47, "maximum": 12666.55, "discounted_cash": 9140.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8360.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8360.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12666.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11097.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7311.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6241.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4550.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9740.5, "maximum": 22303.43, "discounted_cash": 17563.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14720.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14720.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22303.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19540.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12874.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10990.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9740.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 903.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 981.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1085.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HANDLE ENDO GIA 4 STANDARD EGIAUSTND", "code_information": [{"code": "EGIAUSTND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1273.54, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE LARYNGOSCOPE FIBEROPTIC  SINGLE 77700", "code_information": [{"code": "77700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.93, "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": 2.62, "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": 1.92, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 95.16, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 95.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 93.23, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 360.31, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 360.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 484.79, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 484.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 401.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 375.29, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}], "standard_charges": [{"minimum": 74.51, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST W/REPORT", "code_information": [{"code": "94452", "type": "CPT"}], "standard_charges": [{"minimum": 55.86, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 55.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HB GLYCOSYLATED A1C HOME DEV", "code_information": [{"code": "83037", "type": "CPT"}], "standard_charges": [{"minimum": 8.74, "maximum": 584.01, "discounted_cash": 12.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 FULL GENE SEQUENCE", "code_information": [{"code": "81259", "type": "CPT"}], "standard_charges": [{"minimum": 540.0, "maximum": 876.0, "discounted_cash": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 876.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE", "code_information": [{"code": "81257", "type": "CPT"}], "standard_charges": [{"minimum": 92.03, "maximum": 584.01, "discounted_cash": 132.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 343.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 92.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 92.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE DUP/DEL VRNTS", "code_information": [{"code": "81269", "type": "CPT"}], "standard_charges": [{"minimum": 182.16, "maximum": 584.01, "discounted_cash": 263.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 182.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 182.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE FAM VRNT", "code_information": [{"code": "81258", "type": "CPT"}], "standard_charges": [{"minimum": 337.73, "maximum": 584.01, "discounted_cash": 487.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 547.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB FULL GENE SEQUENCE", "code_information": [{"code": "81364", "type": "CPT"}], "standard_charges": [{"minimum": 292.12, "maximum": 584.01, "discounted_cash": 421.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 438.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 438.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 473.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 438.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 438.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE COM VARIANTS", "code_information": [{"code": "81361", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE DUP/DEL VARIANTS", "code_information": [{"code": "81363", "type": "CPT"}], "standard_charges": [{"minimum": 182.16, "maximum": 584.01, "discounted_cash": 263.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 273.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6165.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9342.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8185.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5392.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4603.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3843.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5823.32, "maximum": 14564.75, "discounted_cash": 11478.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9612.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9612.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14564.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12760.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8407.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7177.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5823.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2448.85, "maximum": 6899.02, "discounted_cash": 5060.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4553.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4553.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6899.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6044.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3982.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3399.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2448.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 25.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 199.54, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 226.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 154.01, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 205.05, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 226.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 209.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 166.52, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 198.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 210.75, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 222.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 222.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 240.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 222.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 222.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 210.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 191.05, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 194.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 194.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 210.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 194.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 194.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 454.12, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 454.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 454.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 490.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 454.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1933.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 276.58, "maximum": 3347.0, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 276.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 276.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 298.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 276.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR", "code_information": [{"code": "331T", "type": "CPT"}], "standard_charges": [{"minimum": 1717.46, 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"discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1717.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1717.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1857.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1717.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1717.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"minimum": 156.5, "maximum": 4936.0, "setting": "outpatient", 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"plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", 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"outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.17, "methodology": "fee 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[{"code": "268U", "type": "CPT"}], "standard_charges": [{"minimum": 547.35, "maximum": 547.35, "discounted_cash": 790.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 547.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 547.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AUT DM CGEN TRMBCTPNA 22", "code_information": [{"code": "269U", "type": "CPT"}], "standard_charges": [{"minimum": 547.35, "maximum": 547.35, "discounted_cash": 790.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 547.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 547.35, "methodology": "fee schedule"}], "billing_class": 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"payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM INH THROMBOCYTOPENIA 42", "code_information": [{"code": "276U", "type": "CPT"}], "standard_charges": [{"minimum": 2203.7, "maximum": 2203.7, "discounted_cash": 3183.13, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD HYPOXIC", "code_information": [{"code": "303U", "type": "CPT"}], "standard_charges": [{"minimum": 1981.46, "maximum": 1981.46, "discounted_cash": 2862.11, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1981.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1981.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD NORMOXIC", "code_information": [{"code": "304U", "type": "CPT"}], "standard_charges": [{"minimum": 1868.22, "maximum": 1868.22, "discounted_cash": 2698.54, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1868.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1868.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM RBC FNCLTY&DFRM SHR STRS", 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"billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN IV BNDG", "code_information": [{"code": "280U", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 15.54, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM VWD PROPEPTIDE AG LVL", "code_information": [{"code": "281U", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 15.54, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMATOPOIETIC NUCLEAR TX", "code_information": [{"code": "79403", "type": "CPT"}], "standard_charges": [{"minimum": 90.79, "maximum": 584.01, "discounted_cash": 291.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 98.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMICRT INTRCLRY ALGRFT PRTL", "code_information": [{"code": "20933", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", 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"BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1580.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ACCESS STUDY", "code_information": [{"code": "90940", "type": "CPT"}], "standard_charges": [{"minimum": 65.54, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 65.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 65.54, "methodology": "fee 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"facility"}]}, {"description": "HEMODIALYSIS REPEATED EVAL", "code_information": [{"code": "90937", "type": "CPT"}], "standard_charges": [{"minimum": 122.71, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN CHROMOTOGRAPHY", "code_information": [{"code": "83021", "type": "CPT"}], "standard_charges": [{"minimum": 16.25, "maximum": 584.01, "discounted_cash": 23.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN COPPER SULFATE", "code_information": [{"code": "83026", "type": "CPT"}], "standard_charges": [{"minimum": 3.61, "maximum": 584.01, "discounted_cash": 5.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN ELECTROPHORESIS", "code_information": [{"code": "83020", "type": "CPT"}], "standard_charges": [{"minimum": 11.58, "maximum": 584.01, "discounted_cash": 16.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN F FETAL CHEMICAL", "code_information": [{"code": "83030", "type": "CPT"}], "standard_charges": [{"minimum": 9.67, "maximum": 584.01, "discounted_cash": 13.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85460", "type": "CPT"}], "standard_charges": [{"minimum": 6.96, "maximum": 584.01, "discounted_cash": 10.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85461", "type": "CPT"}], "standard_charges": [{"minimum": 8.42, "maximum": 584.01, "discounted_cash": 12.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.22, "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 - BLUE NETWORK E", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.2, "methodology": "fee 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"plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", "code_information": [{"code": "83065", "type": "CPT"}], "standard_charges": [{"minimum": 4.46, "maximum": 584.01, "discounted_cash": 11.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN UNSTABLE SCREEN", "code_information": [{"code": "83068", "type": "CPT"}], "standard_charges": [{"minimum": 5.31, "maximum": 584.01, "discounted_cash": 12.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN URINE", "code_information": [{"code": "83069", "type": "CPT"}], "standard_charges": [{"minimum": 3.56, "maximum": 584.01, "discounted_cash": 5.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN-OXYGEN AFFINITY", "code_information": [{"code": "82820", "type": "CPT"}], "standard_charges": [{"minimum": 12.01, "maximum": 584.01, "discounted_cash": 17.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 7.98, "maximum": 584.01, "discounted_cash": 11.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS", "code_information": [{"code": "86941", "type": "CPT"}], "standard_charges": [{"minimum": 10.9, "maximum": 584.01, "discounted_cash": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS AUTO", "code_information": [{"code": "86940", "type": "CPT"}], "standard_charges": [{"minimum": 7.89, "maximum": 584.01, "discounted_cash": 11.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 105.7, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [{"code": "86684", "type": "CPT"}], "standard_charges": [{"minimum": 14.26, "maximum": 584.01, "discounted_cash": 20.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY BY STAPLING", "code_information": [{"code": "46947", "type": "CPT"}], "standard_charges": [{"minimum": 499.29, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 499.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 1X2 1961", "code_information": [{"code": "1961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 359.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 2X4 1962", "code_information": [{"code": "1962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 661.57, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORB SURGICEL FIBRILLAR 4X4 1963", "code_information": [{"code": "1963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 826.96, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL NUKNIT 3X4 1943", "code_information": [{"code": "1943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.51, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL NUKNIT 6X9 1946", "code_information": [{"code": "1946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 698.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT ABSORBABLE SURGICEL STRL 2X14 1951", "code_information": [{"code": "1951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOSTAT 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"standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEXA GENE", "code_information": [{"code": "81255", "type": "CPT"}], "standard_charges": [{"minimum": 46.31, "maximum": 584.01, "discounted_cash": 66.89, "setting": "outpatient", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 130.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 58.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 58.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAL", "code_information": [{"code": "83045", "type": "CPT"}], 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"standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 4.52, "maximum": 584.01, "discounted_cash": 6.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": 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"discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": 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"billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.01, "maximum": 47.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9260.28, "maximum": 33673.32, "discounted_cash": 18727.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22224.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22224.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33673.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29502.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19438.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16593.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9260.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13125.68, "maximum": 37875.77, "discounted_cash": 26039.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24998.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24998.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37875.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33184.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21864.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18664.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13125.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7080.1, "maximum": 25448.73, "discounted_cash": 14583.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16796.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16796.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25448.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22296.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14690.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12540.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7080.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/DEBRIDEMENT", "code_information": [{"code": "29862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1004.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1002.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 872.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FEMOROPLASTY", "code_information": [{"code": "29914", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1211.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/LABRAL REPAIR", "code_information": [{"code": "29916", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1231.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROSCOPY DX", "code_information": [{"code": "29860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 814.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP IPOLY XE LINER GROUP E 40MM", "code_information": [{"code": "HDL060E34S", "type": "CDM"}], "standard_charges": [{"gross_charge": 2424.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP REAMER STAGE  2-49MM", "code_information": [{"code": "HAR000S249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP REAMER STAGE 1-47MM", "code_information": [{"code": "HAR000S147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [{"code": "521", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13008.31, "maximum": 42167.7, "discounted_cash": 25663.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27830.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27830.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42167.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36944.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24341.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20779.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13008.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [{"code": "522", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9408.45, "maximum": 30132.96, "discounted_cash": 18935.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19887.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19887.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30132.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26400.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17394.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14848.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9408.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP-PATIENT SPECIFIC IJIGS AND SURGICAL PLAN RIGHT HAA-050-D030-020101", "code_information": [{"code": "HAA-050-D030-020101", "type": "CDM"}], "standard_charges": [{"gross_charge": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HIP-REAMER STAGE 1-53MM", "code_information": [{"code": "HAR000S153", "type": "CDM"}], "standard_charges": [{"gross_charge": 1600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HISTOCHEMICAL STAINS ADD-ON", "code_information": [{"code": "88314", "type": "CPT"}], "standard_charges": [{"minimum": 66.7, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA ANTIBODY", "code_information": [{"code": "86698", "type": "CPT"}], "standard_charges": [{"minimum": 12.41, "maximum": 584.01, "discounted_cash": 17.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA CAPSUL AG IA", "code_information": [{"code": "87385", "type": "CPT"}], "standard_charges": [{"minimum": 11.93, "maximum": 584.01, "discounted_cash": 17.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS SKIN TEST", "code_information": [{"code": "86510", "type": "CPT"}], "standard_charges": [{"minimum": 7.64, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 21417.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV", "code_information": [{"code": "86701", "type": "CPT"}, {"code": "633757", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 8.0, "maximum": 584.01, "gross_charge": 444.0, "discounted_cash": 11.56, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV AG W/HIV1&2 ANTB W/OPTIC", "code_information": [{"code": "87806", "type": "CPT"}], "standard_charges": [{"minimum": 29.49, "maximum": 584.01, "discounted_cash": 42.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 47.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 29.49, "methodology": "fee 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"plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, CLIN STAFF", "code_information": [{"code": "G0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.57, "maximum": 32.57, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, MD 15-30M", "code_information": [{"code": "G0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.78, "maximum": 39.78, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "969", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28225.35, "maximum": 70745.22, "discounted_cash": 54732.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46692.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46692.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 70745.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61982.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40838.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 34861.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 28225.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [{"code": "970", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11841.68, "maximum": 50722.65, "discounted_cash": 23581.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33477.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33477.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50722.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44439.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29280.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 24994.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11841.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [{"code": "975", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6343.71, "maximum": 15539.31, "discounted_cash": 11579.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10256.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10256.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15539.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13614.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8970.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7657.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6343.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [{"code": "974", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13327.41, "maximum": 29625.03, "discounted_cash": 25804.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19552.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19552.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29625.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25955.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17101.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14598.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13327.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC", "code_information": [{"code": "976", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4476.39, "maximum": 11799.36, 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"outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 471.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 471.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 510.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 471.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 471.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 314.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 314.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTT GENE CHARAC ALLELES", "code_information": [{"code": "81274", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 584.01, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTT GENE DETC ABNOR ALLELES", "code_information": [{"code": "81271", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN EPIDIDYMIS PROTEIN 4", "code_information": [{"code": "86305", "type": "CPT"}], "standard_charges": [{"minimum": 18.73, "maximum": 584.01, "discounted_cash": 27.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IM", "code_information": [{"code": "90281", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IV", "code_information": [{"code": "90283", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG SC", "code_information": [{"code": "90284", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMIDIFIER KIT W/ ADAPTER AQUAPAK BUBBLE PREFILLED  HUDRHP340U", "code_information": [{"code": "HUDRHP340U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.98, "setting": "both", "billing_class": "facility"}]}, {"description": "HYALOMATRIX", "code_information": [{"code": "Q4117", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDRATION IV INFUSION INIT", "code_information": [{"code": "96360", "type": "CPT"}], "standard_charges": [{"minimum": 44.34, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE PF 250MG PWD-INJ", "code_information": [{"code": "MED0097", "type": "CDM"}], "standard_charges": [{"gross_charge": 81.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROGEN PEROXIDE TOPICAL SOLUTION 3% 120ML", "code_information": [{"code": "MED0098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.92, "setting": "both", "billing_class": "facility"}]}, {"description": "HYLENEX 150U/ML 1ML", "code_information": [{"code": "MED0569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 147.63, "setting": "both", "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 58.1, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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"percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1155.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 147.98, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5243.13, "maximum": 13100.15, "discounted_cash": 10640.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8646.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8646.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13100.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11477.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7562.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6455.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5243.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2816.3, "maximum": 5715.23, "discounted_cash": 6751.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3772.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3772.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5715.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5007.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3299.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2816.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3350.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [{"code": "78", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4453.63, "maximum": 10318.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6810.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6810.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10318.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9040.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5956.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5084.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4453.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [{"code": "77", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6901.14, "maximum": 17188.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11344.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11344.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17188.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15059.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9922.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8469.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6901.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC", "code_information": [{"code": "79", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2975.48, "maximum": 9296.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6136.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6136.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9296.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8145.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5366.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4581.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2975.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 383.79, "maximum": 626.56, "discounted_cash": 482.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 383.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 383.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 415.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 383.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 383.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 626.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1221.99, "discounted_cash": 870.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 733.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 733.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 793.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 733.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 733.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1221.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1204.11, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1113.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1113.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1204.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1113.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1113.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 799.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1275.46, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1077.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1077.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1164.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1077.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1077.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1275.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 345.4, "maximum": 843.73, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 345.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 345.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 373.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 345.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 345.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 843.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 145.4, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"minimum": 255.1, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 86.58, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 93.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1260.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1168.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY ABLATION", "code_information": [{"code": "58563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2640.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY BIOPSY", "code_information": [{"code": "58558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1670.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "type": "CPT"}], "standard_charges": [{"minimum": 433.18, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "type": "CPT"}], "standard_charges": [{"minimum": 332.89, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE FB", "code_information": [{"code": "58562", "type": "CPT"}], "standard_charges": [{"minimum": 527.66, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 527.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE MYOMA", "code_information": [{"code": "58561", "type": "CPT"}], "standard_charges": [{"minimum": 419.16, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 419.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "type": "CPT"}], "standard_charges": [{"minimum": 366.99, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 366.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY STERILIZATION", "code_information": [{"code": "58565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2084.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HZV VACC RECOMBINANT IM", "code_information": [{"code": "90750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HZV VACCINE LIVE SUBQ", "code_information": [{"code": "90736", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; each additional 25 sq cm or part thereof (List separately in addition to code for primary procedure)", "code_information": [{"code": "15012", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; first 25 sq cm or less", "code_information": [{"code": "15011", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1477.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hearing Test Using Earphones, (Sisi) Sensitivity Index", "code_information": [{"code": "92564", "type": "CPT"}], "standard_charges": [{"minimum": 50.56, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hematocrit", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "633742", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.13, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 3.08, "estimated_discounted_cash": 11.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hemoglobin", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "633741", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.13, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 3.08, "estimated_discounted_cash": 11.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hemoglobin A1c", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "633743", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.74, "maximum": 584.01, "gross_charge": 31.0, "discounted_cash": 12.62, "estimated_discounted_cash": 31.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hepatic Function Panel", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "633744", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.35, "maximum": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hospice Service General Inpatient Care (Nonrespite)", "code_information": [{"code": "656", "type": "RC"}], "standard_charges": [{"minimum": 549.0, "maximum": 549.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 549.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Hospice Service 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[{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE 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"maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS COMP/MULTIPLE", "code_information": [{"code": "10061", "type": "CPT"}], "standard_charges": [{"minimum": 293.09, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D COMPLEX PO WOUND INFCTJ", "code_information": [{"code": "10180", "type": "CPT"}], "standard_charges": [{"minimum": 378.68, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 378.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST COMP", "code_information": [{"code": "10081", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 500.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST SIMPLE", "code_information": [{"code": "10080", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 354.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E BURSA", "code_information": [{"code": "23931", "type": "CPT"}], "standard_charges": [{"minimum": 426.26, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 426.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E DP ABSC/HMTMA", "code_information": [{"code": "23930", "type": "CPT"}], "standard_charges": [{"minimum": 501.41, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECTIOUS AGENT ANTIBODY", "code_information": [{"code": "86318", "type": "CPT"}], "standard_charges": [{"minimum": 16.28, "maximum": 584.01, "discounted_cash": 23.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA NFCT AB SARSCOV2 COVID19", "code_information": [{"code": "86328", "type": "CPT"}], "standard_charges": [{"minimum": 40.75, "maximum": 584.01, "discounted_cash": 58.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADI 16S&18S RRNA GENES", "code_information": [{"code": "112U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 320.52, "discounted_cash": 462.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee 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BRTNLA DDPCR FLWG LIQ", "code_information": [{"code": "302U", "type": "CPT"}], "standard_charges": [{"minimum": 325.23, "maximum": 325.23, "discounted_cash": 469.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CHLMYD&GONORR AMP PRB", "code_information": [{"code": "353U", "type": "CPT"}], "standard_charges": [{"minimum": 63.16, "maximum": 63.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 63.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 63.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CNS PTHGN NEXT GEN SEQ", "code_information": [{"code": "323U", "type": "CPT"}], "standard_charges": [{"minimum": 1913.58, "maximum": 1913.58, "discounted_cash": 2764.06, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GI PTHGN 31 ORG&21 ARG", "code_information": [{"code": "369U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 20BCT&FNG ORG", "code_information": [{"code": "321U", "type": "CPT"}], "standard_charges": [{"minimum": 571.36, "maximum": 571.36, "discounted_cash": 825.29, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 21 ORG&21ARG", "code_information": [{"code": "374U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN SEMIQ DNA16&1", "code_information": [{"code": "371U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA RSP TR NFCT 17 8 13&16", "code_information": [{"code": "373U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA SURG WND PTHGN 34&21", "code_information": [{"code": "370U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [{"code": "87507", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 828.08, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 765.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 765.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 828.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 765.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 765.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 6-11", "code_information": [{"code": "87506", "type": "CPT"}], "standard_charges": [{"minimum": 236.69, "maximum": 584.01, "discounted_cash": 341.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 392.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 392.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 424.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 392.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 392.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2203.7, "discounted_cash": 3183.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC ADVANCE FOLEY TRAY 16FR W/STATLOCK LF", "code_information": [{"code": "897516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.64, "setting": "both", "billing_class": "facility"}]}, {"description": "IC INF PBW 2501-5000 G SUBSQ", "code_information": [{"code": "99480", "type": "CPT"}], "standard_charges": [{"minimum": 140.49, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC LBW INF 1500-2500 G SUBSQ", "code_information": [{"code": "99479", "type": "CPT"}], "standard_charges": [{"minimum": 146.18, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC LBW INF < 1500 GM SUBSQ", "code_information": [{"code": "99478", "type": "CPT"}], "standard_charges": [{"minimum": 160.93, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICAR CATH ABLTJ DSCRT ARRHYT", "code_information": [{"code": "93655", "type": "CPT"}], "standard_charges": [{"minimum": 342.66, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 342.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 260.76, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 341.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 341.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 368.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 341.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 9.94, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 16.02, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 6.0, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 208.24, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDENTIFY SPERM TISSUE", "code_information": [{"code": "89264", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDET 1 OR MORE LEVELS", "code_information": [{"code": "22527", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDET SINGLE LEVEL", "code_information": [{"code": "22526", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH1 COMMON VARIANTS", "code_information": [{"code": "81120", "type": "CPT"}], "standard_charges": [{"minimum": 173.93, "maximum": 584.01, "discounted_cash": 251.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH2 COMMON VARIANTS", "code_information": [{"code": "81121", "type": "CPT"}], "standard_charges": [{"minimum": 266.21, "maximum": 584.01, "discounted_cash": 384.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 431.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFNL3 GENE", "code_information": [{"code": "81283", "type": "CPT"}], "standard_charges": [{"minimum": 66.03, "maximum": 584.01, "discounted_cash": 95.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 101.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 101.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 110.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 101.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 101.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IG LIGHT CHAINS FREE EACH", "code_information": [{"code": "83521", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 584.01, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.54, "methodology": "fee 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"plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 39.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 39.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGG 1 2 3 OR 4 EACH", "code_information": [{"code": "82787", "type": "CPT"}], "standard_charges": [{"minimum": 7.22, "maximum": 584.01, "discounted_cash": 10.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 61.7, "maximum": 584.01, "discounted_cash": 89.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANGE AMP METH", "code_information": [{"code": "81261", "type": "CPT"}], "standard_charges": [{"minimum": 178.19, "maximum": 584.01, "discounted_cash": 257.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 394.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 178.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 178.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH VARI REGIONAL MUTATION", "code_information": [{"code": "81263", "type": "CPT"}], "standard_charges": [{"minimum": 265.07, "maximum": 586.61, "discounted_cash": 382.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 542.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 542.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 586.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 542.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 542.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 186.58, "maximum": 584.01, "discounted_cash": 269.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 279.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 279.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 302.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 279.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 279.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGK REARRANGEABN CLONAL POP", "code_information": [{"code": "81264", "type": "CPT"}], "standard_charges": [{"minimum": 155.46, "maximum": 584.01, "discounted_cash": 224.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 275.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 275.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 297.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 275.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 275.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV VACC PANDEMIC ADJUVT IM", "code_information": [{"code": "90667", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV VACCINE PANDEMIC IM", "code_information": [{"code": "90668", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90658", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90686", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IKBKAP GENE", "code_information": [{"code": "81260", "type": "CPT"}], "standard_charges": [{"minimum": 35.38, "maximum": 584.01, "discounted_cash": 51.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 204.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1274.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC ART ANGIO,CARDIAC CATH", "code_information": [{"code": "G0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.3, "maximum": 17.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3109.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILLUMINATOR BIFURCATED ACCESS", "code_information": [{"code": "AC01-90046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 31.29, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 12.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1108.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1107.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 975.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMFLUOR 1ST 1ANTB STAIN PX", "code_information": [{"code": "88346", "type": "CPT"}], "standard_charges": [{"minimum": 76.68, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 82.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMFLUOR EA ADDL 1ANTB STN PX", "code_information": [{"code": "88350", "type": "CPT"}], "standard_charges": [{"minimum": 52.96, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 52.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 52.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 52.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 52.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 104.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 57.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 57.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 18.21, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"minimum": 61.11, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"minimum": 24.34, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMHCHEM/IMCYTCHM EA MLT ANTB", "code_information": [{"code": "88344", "type": "CPT"}], "standard_charges": [{"minimum": 93.02, "maximum": 584.01, "discounted_cash": 448.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 93.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 93.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 100.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 93.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 93.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 1 STING INSECT", "code_information": [{"code": "95130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 2 STING INSECTS", "code_information": [{"code": "95131", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 3 STING INSECTS", "code_information": [{"code": "95132", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 4 STING INSECTS", "code_information": [{"code": "95133", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 5 STING INSECTS", "code_information": [{"code": "95134", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL", "code_information": [{"code": "90473", "type": "CPT"}], "standard_charges": [{"minimum": 23.33, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL ADDL", "code_information": [{"code": "90474", "type": "CPT"}], "standard_charges": [{"minimum": 16.68, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE COMPLEX ASSAY", "code_information": [{"code": "86332", "type": "CPT"}], "standard_charges": [{"minimum": 21.93, "maximum": 584.01, "discounted_cash": 31.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [{"code": "86335", "type": "CPT"}], "standard_charges": [{"minimum": 26.42, "maximum": 584.01, "discounted_cash": 38.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 54.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 54.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 58.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 54.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 54.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN EACH ADD", "code_information": [{"code": "90472", "type": "CPT"}], "standard_charges": [{"minimum": 21.5, "maximum": 584.01, "setting": 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95115", "type": "CPT"}], "standard_charges": [{"minimum": 13.4, "maximum": 584.01, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 462.42, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 462.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 729.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 787.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SKULL PERQ ESP", "code_information": [{"code": "69714", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 584.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1571.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61533", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1906.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1968.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT CAPSTONE 9X26MM", "code_information": [{"code": "2990926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT COCHLEAR DEVICE", "code_information": [{"code": "69930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 14067.0, "discounted_cash": 41225.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 17445.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT HORMONE PELLET(S)", "code_information": [{"code": "11980", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"minimum": 325.98, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 325.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"minimum": 573.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 573.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1896.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2789.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1257.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1937.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6923.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6331.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64561", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 983.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 14067.0, "discounted_cash": 38581.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1191.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62351", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE CROSSLINK ROD TO ROD L  G3602537", "code_information": [{"code": "G3602537", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY CONNECTOR LTRL OPEN ANGLED 19MM 3602519A", "code_information": [{"code": "3602519A", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY DOMINO AXIAL 3.5 TO 3.5MM G3602350", "code_information": [{"code": "G3602350", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY DOMINO AXIAL 3.5 TO 4.75MM G3602475", "code_information": [{"code": "G3602475", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY DOMINO AXIAL 3.5 TO 5.5/6.0MM G3602550", "code_information": [{"code": "G3602550", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY DOMINO OFFSET 3.5 TO 4.75MM 3601475", "code_information": [{"code": "3601475", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFINITY DOMINO OFFSET O/O 3.5 TO 4.75 3603475", "code_information": [{"code": "3603475", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 10032.0, "discounted_cash": 22535.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 594.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1506.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT TIBIAL SIZE 4 8MM 1516-10-408", "code_information": [{"code": "1516-10-408", "type": "CDM"}], "standard_charges": [{"gross_charge": 15970.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1124.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1542.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1899.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT WEDGE BONE ILIUM TRICORTICAL LYO 6MM", "code_information": [{"code": "3406318", "type": "CDM"}], "standard_charges": [{"gross_charge": 1832.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE DEVICE INTRA OR EPI.DRUG INFUSION;SUBCUT.RES.PROGRAM PUMP 62362", "code_information": [{"code": "62362", "type": "CPT"}, {"code": "1481037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 488.64, "maximum": 10032.0, "gross_charge": 3437.0, "discounted_cash": 22535.24, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEARING AID", "code_information": [{"code": "69710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REV.OR REPOSITION TUNNEL INTRA.OR EPI.CATH FOR LONG-TERM MED.ADMIN. 62350", "code_information": [{"code": "62350", "type": "CPT"}, {"code": "1481038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 500.06, "maximum": 6090.0, "gross_charge": 3387.0, "discounted_cash": 10972.46, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 500.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTATION OF NERVE END INTO BONE OR MUSCLE 64787", "code_information": [{"code": "64787", "type": "CPT"}, {"code": "1857257", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 271.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 100.09, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 100.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 10032.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2768.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3025.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN GNOTYP CD44 EXONS 2 3 6", "code_information": [{"code": "191U", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 401.25, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4052.84, "maximum": 8224.59, "discounted_cash": 12715.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5428.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5428.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8224.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7205.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4747.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4052.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5539.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC DP OPN B1 CRTX HUM/ELBW", "code_information": [{"code": "23935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 94.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "type": "CPT"}], "standard_charges": [{"minimum": 200.47, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 200.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2208.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1884.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 676.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2863.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2938.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADDER", "code_information": [{"code": "51040", "type": "CPT"}], "standard_charges": [{"minimum": 366.86, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 366.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 586.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1559.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 609.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 568.18, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 568.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE EXTERNAL HEMORRHOID", "code_information": [{"code": "46083", "type": "CPT"}], "standard_charges": [{"minimum": 297.12, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 297.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE FINGER TENDON SHEATH", "code_information": [{"code": "26055", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 828.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 451.3, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 451.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HAND/FINGER TENDON", "code_information": [{"code": "26460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 807.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 296.07, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 296.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69915", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1754.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2028.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"minimum": 417.23, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 417.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 694.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65875", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 741.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 775.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2676.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2485.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2459.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2359.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2590.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2005.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1870.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1755.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1600.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1991.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2124.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2120.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 525.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 649.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1996.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1746.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1485.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV HALF SEGMNT", "code_information": [{"code": "63185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1569.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"minimum": 142.22, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 904.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE THIGH TENDON & FASCIA", "code_information": [{"code": "27305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE WRIST/FOREARM TENDON", "code_information": [{"code": "25290", "type": "CPT"}], "standard_charges": [{"minimum": 548.41, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 548.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 163.36, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 392.84, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 392.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"minimum": 440.69, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 440.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/GRAFT MIDFOOT BONES", "code_information": [{"code": "28305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE NECK 21501", "code_information": [{"code": "21501", "type": "CPT"}, {"code": "1481053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 680.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF CYST 10121", "code_information": [{"code": "10121", "type": "CPT"}, {"code": "1481055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 365.65, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 365.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE OF HEMATOMA 10140", "code_information": [{"code": "10140", "type": "CPT"}, {"code": "1481057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SPINE CERVICAL 22010", "code_information": [{"code": "22010", "type": "CPT"}, {"code": "1481066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3437.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1229.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SPINE LUMBAR 22015", "code_information": [{"code": "22015", "type": "CPT"}, {"code": "1481065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3437.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1197.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE SURGERY SIMPLE 10060", "code_information": [{"code": "10060", "type": "CPT"}, {"code": "1481064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 250.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND REMOVAL OF FOREIGN BODY 10120", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "1481072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27605", "type": "CPT"}], "standard_charges": [{"minimum": 449.23, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 449.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27606", "type": "CPT"}], "standard_charges": [{"minimum": 340.28, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 340.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL ABSCESS", "code_information": [{"code": "46050", "type": "CPT"}], "standard_charges": [{"minimum": 351.26, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 351.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 379.04, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 379.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SPHINCTER", "code_information": [{"code": "46080", "type": "CPT"}], "standard_charges": [{"minimum": 415.73, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 415.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANKLE BONE", "code_information": [{"code": "28302", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 888.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1621.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1674.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2641.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3127.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 632.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 238.58, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 238.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 412.3, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69420", "type": "CPT"}], "standard_charges": [{"minimum": 253.63, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69421", "type": "CPT"}], "standard_charges": [{"minimum": 183.97, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 720.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1646.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "66172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 317.04, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 317.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID FOLD", "code_information": [{"code": "67715", "type": "CPT"}], "standard_charges": [{"minimum": 362.09, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 577.91, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 577.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FIBULA", "code_information": [{"code": "27707", "type": "CPT"}], "standard_charges": [{"minimum": 518.9, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"minimum": 323.56, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 323.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 605.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT FASCIA", "code_information": [{"code": "28008", "type": "CPT"}], "standard_charges": [{"minimum": 565.77, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 565.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON", "code_information": [{"code": "28234", "type": "CPT"}], "standard_charges": [{"minimum": 548.32, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 548.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON(S)", "code_information": [{"code": "28230", "type": "CPT"}], "standard_charges": [{"minimum": 575.7, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 575.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1097.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 402.52, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1027.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEEL BONE", "code_information": [{"code": "28300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1542.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1885.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27000", "type": "CPT"}], "standard_charges": [{"minimum": 489.18, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 489.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27001", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 752.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDONS", "code_information": [{"code": "27006", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 872.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP/THIGH FASCIA", "code_information": [{"code": "27025", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1159.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66500", "type": "CPT"}], "standard_charges": [{"minimum": 473.05, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 473.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 513.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 900.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 556.57, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 556.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF KNEE JOINT", "code_information": [{"code": "27435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1004.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1205.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIP FOLD", "code_information": [{"code": "40806", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2598.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28306", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28307", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1111.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28308", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSALS", "code_information": [{"code": "28309", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1115.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF MIDFOOT BONES", "code_information": [{"code": "28304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1157.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1472.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 605.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 888.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 650.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1039.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 527.35, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 527.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON & MUSCLE", "code_information": [{"code": "23405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 761.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON SHEATH", "code_information": [{"code": "25000", "type": "CPT"}], "standard_charges": [{"minimum": 449.9, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 449.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1005.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1227.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"minimum": 437.82, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 437.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27390", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 556.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27307", "type": "CPT"}], "standard_charges": [{"minimum": 508.67, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 508.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 888.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA", "code_information": [{"code": "27705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 919.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA & FIBULA", "code_information": [{"code": "27709", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1392.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28010", "type": "CPT"}], "standard_charges": [{"minimum": 317.15, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 317.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28232", "type": "CPT"}], "standard_charges": [{"minimum": 499.68, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 499.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "28011", "type": "CPT"}], "standard_charges": [{"minimum": 431.23, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 431.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE FOLD", "code_information": [{"code": "41010", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 278.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 575.13, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 575.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53000", "type": "CPT"}], "standard_charges": [{"minimum": 186.62, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53010", "type": "CPT"}], "standard_charges": [{"minimum": 377.89, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 377.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53020", "type": "CPT"}], "standard_charges": [{"minimum": 116.77, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53025", "type": "CPT"}], "standard_charges": [{"minimum": 84.62, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 84.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 666.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 362.46, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 511.12, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 511.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 371.43, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 371.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 399.68, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 399.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1145.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WRIST CAPSULE", "code_information": [{"code": "25085", "type": "CPT"}], "standard_charges": [{"minimum": 563.76, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION SECONDARY CATARACT", "code_information": [{"code": "66820", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 564.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1662.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDICATOR CHEMICAL STERRAD CYCLESURE STRL", "code_information": [{"code": "14324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.44, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TAPE STEAM 12MM", "code_information": [{"code": "132212MM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TEMP ULTRA FOREHEAD 100EA PK 14677-493", "code_information": [{"code": "14677-493", "type": "CDM"}], "standard_charges": [{"gross_charge": 2.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TEMPERATURE FOREHEAD ULTRA", "code_information": [{"code": "493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.57, "setting": "both", "billing_class": "facility"}]}, {"description": "INDICATOR TEST PACK STERILIZATION ATTEST RAPID5 STEAM CHEMICAL 16EA INTEGRATOR", "code_information": [{"code": "41382", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.32, "setting": "both", "billing_class": "facility"}]}, {"description": "INDIGO CARMINE 0.8% INJ 5 ML", "code_information": [{"code": "MED0099", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 534.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INDUCTION OF VOMITING", "code_information": [{"code": "99175", "type": "CPT"}], "standard_charges": [{"minimum": 47.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "758", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4549.14, "maximum": 9457.93, "discounted_cash": 8753.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6242.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6242.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9457.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8286.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5459.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4660.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4549.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "757", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6316.48, "maximum": 15886.19, "discounted_cash": 12803.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10485.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10485.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15886.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13918.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9170.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7828.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6316.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "759", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2856.32, "maximum": 6279.59, "discounted_cash": 5933.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4144.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4144.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6279.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5501.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3624.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3094.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2856.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "854", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8917.52, "maximum": 54659.44, "discounted_cash": 17865.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36075.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36075.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54659.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47889.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31552.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26934.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8917.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "853", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22320.8, "maximum": 72117.59, "discounted_cash": 44157.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47598.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47598.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72117.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63184.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 41630.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 35537.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22320.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "855", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7255.05, "maximum": 46335.74, "discounted_cash": 13387.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30581.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30581.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46335.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40596.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26747.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 22832.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7255.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "727", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4145.09, "maximum": 8411.79, "discounted_cash": 13259.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5551.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5551.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8411.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7369.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4855.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4145.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6557.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [{"code": "728", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2979.09, "maximum": 6045.59, "discounted_cash": 7253.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3990.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3990.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6045.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5296.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3489.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2979.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3646.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [{"code": "386", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4429.53, "maximum": 10159.95, "discounted_cash": 8729.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6705.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6705.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10159.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8901.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5864.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5006.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4429.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [{"code": "385", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7251.48, "maximum": 15357.61, "discounted_cash": 14147.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10136.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10136.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15357.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13455.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8865.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7567.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7251.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC", "code_information": [{"code": "387", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2991.55, "maximum": 7628.56, "discounted_cash": 6091.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5034.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5034.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7628.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6683.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4403.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3759.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2991.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLATION DEVICE Disposable Balloon Inflation Device  60 ml with lock 131-4493", "code_information": [{"code": "DB25011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLUENZA A AG IF", "code_information": [{"code": "87276", "type": "CPT"}], "standard_charges": [{"minimum": 14.46, "maximum": 584.01, "discounted_cash": 20.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA A/B EACH AG IA", "code_information": [{"code": "87400", "type": "CPT"}], "standard_charges": [{"minimum": 12.72, "maximum": 584.01, "discounted_cash": 18.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA B AG IF", "code_information": [{"code": "87275", "type": "CPT"}], "standard_charges": [{"minimum": 11.03, "maximum": 584.01, "discounted_cash": 15.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 46.18, "maximum": 584.01, "discounted_cash": 66.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 102.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": "87503", "type": "CPT"}], "standard_charges": [{"minimum": 26.3, "maximum": 584.01, "discounted_cash": 37.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROBE", "code_information": [{"code": "87502", "type": "CPT"}], "standard_charges": [{"minimum": 86.22, "maximum": 584.01, "discounted_cash": 124.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 156.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 156.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 169.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 156.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 156.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 86.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 86.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS ANTIBODY", "code_information": [{"code": "86710", "type": "CPT"}], "standard_charges": [{"minimum": 12.2, "maximum": 584.01, "discounted_cash": 17.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 8.84, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3641.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 132.34, "maximum": 584.01, "discounted_cash": 482.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 143.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 174.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 116.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 167.06, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 167.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6714.58, "maximum": 19660.55, "discounted_cash": 13631.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12976.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12976.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19660.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17225.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11349.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9688.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6714.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10794.66, "maximum": 32885.96, "discounted_cash": 22280.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21704.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21704.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32885.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28812.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18983.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16205.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10794.66, "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": 4920.9, "maximum": 12628.01, "discounted_cash": 10441.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8334.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8334.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12628.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11063.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7289.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6222.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4920.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}], "standard_charges": [{"minimum": 14.03, "maximum": 584.01, "discounted_cash": 20.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT DAY HOSP NEONATE CARE", "code_information": [{"code": "99477", "type": "CPT"}], "standard_charges": [{"minimum": 410.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY HOSP", "code_information": [{"code": "99460", "type": "CPT"}], "standard_charges": [{"minimum": 112.22, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY NON-FAC", "code_information": [{"code": "99461", "type": "CPT"}], "standard_charges": [{"minimum": 127.3, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 1-4 YRS", "code_information": [{"code": "99382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 65+ YRS", "code_information": [{"code": "99387", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT INFANT", "code_information": [{"code": "99381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.98, "maximum": 81.98, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL FOOT EXAM PT LOPS", "code_information": [{"code": "G0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.87, "maximum": 134.05, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 124.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 124.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 124.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL PREVENTIVE EXAM", "code_information": [{"code": "G0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 237.32, "maximum": 237.32, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 237.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL TREATMENT OF BURN(S)", "code_information": [{"code": "16000", "type": "CPT"}], "standard_charges": [{"minimum": 119.34, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"minimum": 90.18, "maximum": 90.18, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIAG/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 2ND LEVEL 64494", "code_information": [{"code": "64494", "type": "CPT"}, {"code": "1582410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 128.51, "maximum": 4936.0, "gross_charge": 1179.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 471.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 707.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 766.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 64493", "code_information": [{"code": "64493", "type": "CPT"}, {"code": "1582416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 253.53, "maximum": 4936.0, "gross_charge": 3707.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1482.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2224.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2409.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 154.27, "maximum": 4936.0, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 352.25, "maximum": 4936.0, "gross_charge": 3545.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1418.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2127.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2304.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "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": 156.98, "maximum": 4936.0, "gross_charge": 435.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 156.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 273.53, "maximum": 4936.0, "gross_charge": 3893.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1557.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2335.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2530.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 273.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT EPIDURAL PATCH", "code_information": [{"code": "62273", "type": "CPT"}], "standard_charges": [{"minimum": 230.91, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 101.33, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"minimum": 179.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"minimum": 75.76, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 92.36, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT TRIGGER POINTS 3/>", "code_information": [{"code": "20553", "type": "CPT"}], "standard_charges": [{"minimum": 80.13, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1440.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 106.92, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 114.81, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 69.98, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"minimum": 48.25, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ANESTHETIC AGENT AND/OR STEROID GENICULAR NERVE BRANCH W/IMAGE 64454", "code_information": [{"code": "64454", "type": "CPT"}, {"code": "45577564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 312.38, "maximum": 4936.0, "gross_charge": 1303.5, "discounted_cash": 882.57, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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LUMBAR/SACRAL  W/IMAGE 62323", "code_information": [{"code": "62323", "type": "CPT"}, {"code": "44660564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 882.57, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL  W/O IMAGE 62322", "code_information": [{"code": "62322", "type": "CPT"}, {"code": "44660563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 195.26, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC OR THERAPEUTIC AGENT W/ IMAGE GUIDANCE LUMBAR/SACRAL 3RD LEVEL 64495", "code_information": [{"code": "64495", "type": "CPT"}, {"code": "1582412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 132.45, "maximum": 4936.0, "gross_charge": 1179.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 471.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 707.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 766.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 132.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 137.31, "maximum": 4936.0, "gross_charge": 1179.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 471.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 707.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 766.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 137.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 136.51, "maximum": 4936.0, "gross_charge": 1144.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 686.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 743.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 322.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 322.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EYE DRUG", "code_information": [{"code": "67028", "type": "CPT"}], "standard_charges": [{"minimum": 153.89, "maximum": 4936.0, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"minimum": 273.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 273.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"minimum": 274.47, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 274.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51610", "type": "CPT"}], "standard_charges": [{"minimum": 170.44, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 525.81, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 525.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1071.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27093", "type": "CPT"}], "standard_charges": [{"minimum": 307.59, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27095", "type": "CPT"}], "standard_charges": [{"minimum": 429.76, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 429.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR MYELOGRAM", "code_information": [{"code": "62284", "type": "CPT"}], "standard_charges": [{"minimum": 240.12, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 196.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 208.46, "maximum": 4936.0, "gross_charge": 3747.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1498.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2248.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2435.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 208.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 150.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 76.15, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 170.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"minimum": 156.47, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 156.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST X-RAY", "code_information": [{"code": "25246", "type": "CPT"}], "standard_charges": [{"minimum": 249.73, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION HEPARIN SODIUM 500 ML .9 PCT NACL 100 UNIT", "code_information": [{"code": "2B0953", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.59, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/IMAGE 62325", "code_information": [{"code": "62325", "type": "CPT"}, {"code": "44660572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 354.08, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 354.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/O IMAGE 62324", "code_information": [{"code": "62324", "type": "CPT"}, {"code": "44660571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 206.6, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL  W/IMAGE 62327", "code_information": [{"code": "62327", "type": "CPT"}, {"code": "44660574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 364.58, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 364.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INC. CATH. PLACEMENT DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL  W/O IMAGE 62326", "code_information": [{"code": "62326", "type": "CPT"}, {"code": "44660573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 205.89, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 1105.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 136.11, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 133.49, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 133.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"minimum": 472.38, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 472.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1211.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO VOCAL CORD", "code_information": [{"code": "31513", "type": "CPT"}], "standard_charges": [{"minimum": 152.65, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 124.33, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"minimum": 292.9, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 292.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Lower 129-0170 22/5 2.3 230 2.8", "code_information": [{"code": "IN33151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.34, "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": 97.34, "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": 97.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Upper 129-0171 25/5 2.3 180 2.8", "code_information": [{"code": "IN33221", "type": "CDM"}], "standard_charges": [{"gross_charge": 97.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION OF HIV PREP DRUG", "code_information": [{"code": "G0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.71, "maximum": 20.71, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCEDURE FOR DISCOGRAPHY;LUMBAR 62290", "code_information": [{"code": "62290", "type": "CPT"}, {"code": "1481127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 493.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PX FOR ELBOW ARTHG", "code_information": [{"code": "24220", "type": "CPT"}], "standard_charges": [{"minimum": 248.02, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION RECTUS SHEATH 20550", "code_information": [{"code": "20550", "type": "CPT"}, {"code": "1481130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 80.82, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SACROILIAC JOINT STEROID W/ OR W/O ARTHROGRAPHY G0260", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "1618454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 882.57, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SINGLE TENDON 20551", "code_information": [{"code": "20551", "type": "CPT"}, {"code": "1481132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 81.01, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66020", "type": "CPT"}], "standard_charges": [{"minimum": 262.56, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 262.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64600", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 694.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64605", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1426.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64610", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1118.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64620", "type": "CPT"}], "standard_charges": [{"minimum": 301.87, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 301.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64630", "type": "CPT"}], "standard_charges": [{"minimum": 362.61, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64680", "type": "CPT"}], "standard_charges": [{"minimum": 461.18, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 461.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"minimum": 147.59, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 69.42, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION WATER 1000 ML PLASTIC CONTAINER FOR IRRIGATION STRL", "code_information": [{"code": "2B7114X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 19.83, "setting": "both", "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4817.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNOVABRN/INNOVAMATX XL SQCM", "code_information": [{"code": "A2022", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX AC, PER SQ CM", "code_information": [{"code": "A2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX FS, PER SQ CM", "code_information": [{"code": "A2013", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT30", "code_information": [{"code": "G0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.35, "maximum": 115.35, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 115.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT50", "code_information": [{"code": "G0426", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.98, "maximum": 160.98, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT70", "code_information": [{"code": "G0427", "type": "HCPCS"}], "standard_charges": [{"minimum": 232.55, "maximum": 232.55, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 232.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 15", "code_information": [{"code": "G0406", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.19, "maximum": 49.19, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 25", "code_information": [{"code": "G0407", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.56, "maximum": 87.56, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 35", "code_information": [{"code": "G0408", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.12, "maximum": 128.12, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1576.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1048.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1786.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 149.25, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1764.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1612.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2507.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2504.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 96.17, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2480.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 628.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 652.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2214.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS TUN IP CATH FOR DIAL OPN", "code_information": [{"code": "49421", "type": "CPT"}], "standard_charges": [{"minimum": 270.52, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 303.24, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 303.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLCM PRQ ELTRD RA PN EA", "code_information": [{"code": "64597", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"minimum": 435.21, "maximum": 6923.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 435.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"minimum": 433.77, "maximum": 6923.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 973.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1193.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH COMPLEX", "code_information": [{"code": "51703", "type": "CPT"}], "standard_charges": [{"minimum": 205.57, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATHETER", "code_information": [{"code": "51701", "type": "CPT"}], "standard_charges": [{"minimum": 60.43, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 712.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 192.29, "maximum": 6923.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 192.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 857.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1107.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 169.42, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 10096.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.48, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 234.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 185.69, "maximum": 6923.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"minimum": 464.46, "maximum": 945.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 464.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 464.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 501.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 464.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 945.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EMERGENCY AIRWAY", "code_information": [{"code": "31500", "type": "CPT"}], "standard_charges": [{"minimum": 178.49, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1259.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1008.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EYE SOCKET IMPLANT", "code_information": [{"code": "67550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1285.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 528.16, "maximum": 8117.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 528.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 554.85, "maximum": 8117.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 554.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 958.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 574.44, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 574.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 295.81, "maximum": 10032.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 295.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY DEVICE W/ANT. INST. ANCHOR INTERVERT. DISC EA CONTIGOUS DEFECT 22854", "code_information": [{"code": "22854", "type": "CPT"}, {"code": "44660497", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 384.55, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY DEVICE W/ANT. INST. ANCHOR INTERVERT. DISC EA SPACE 22853", "code_information": [{"code": "22853", "type": "CPT"}, {"code": "44660496", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 294.21, "maximum": 4936.0, "gross_charge": 4737.0, "estimated_discounted_cash": 5789.67, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 294.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERLAMINAR DISTRACTION DEV. W/O FUSION SECOND LEVEL LUMBAR 22870", "code_information": [{"code": "22870", "type": "CPT"}, {"code": "44660510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 138.45, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTERLAMINAR DISTRACTION DEV. W/O FUSION SINGLE LEVEL LUMBAR 22869", "code_information": [{"code": "22869", "type": "CPT"}, {"code": "44660507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 536.14, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 536.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2316.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTRAUTERINE DEVICE", "code_information": [{"code": "58300", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ITOTAL IDENTITY CR FULL KIT 2 PC IPOLY XE BXTDM215614E", "code_information": [{"code": "BXTDM215614E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.04, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LENS PROSTHESIS", "code_information": [{"code": "66985", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 891.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1789.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2321.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "type": "CPT"}], "standard_charges": [{"minimum": 294.1, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 294.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MULTI-COMP PENIS PROS", "code_information": [{"code": "54405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 395.57, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 395.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 76.74, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 166.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 285.57, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36556", "type": "CPT"}], "standard_charges": [{"minimum": 315.09, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1022.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1034.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 580.13, "maximum": 9225.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 580.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 93.5, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2078.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1761.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1035.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 861.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 399.12, "maximum": 8117.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 399.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 418.27, "maximum": 8117.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 418.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 384.13, "maximum": 8117.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SELF-CONTD PROSTHESIS", "code_information": [{"code": "54401", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16495.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 654.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1129.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 908.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE INFUSION DEVICE", "code_information": [{"code": "62360", "type": "CPT"}], "standard_charges": [{"minimum": 408.36, "maximum": 6090.0, "discounted_cash": 22535.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 138.17, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TEMP BLADDER CATH", "code_information": [{"code": "51702", "type": "CPT"}], "standard_charges": [{"minimum": 86.71, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1256.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1241.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1653.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1041.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1759.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36561", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1270.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1527.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1131.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5784.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1229.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK SPHINCTER", "code_information": [{"code": "53445", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 930.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "type": "CPT"}], "standard_charges": [{"minimum": 538.26, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 538.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT/PLACE HEART CATHETER", "code_information": [{"code": "93503", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT/REPLACE PERIPHERAL/GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECIEVER 64590", "code_information": [{"code": "64590", "type": "CPT"}, {"code": "1481141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 569.98, "maximum": 10032.0, "gross_charge": 4737.0, "discounted_cash": 24255.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 569.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTER TIP 6MM PRO-DISC CF EXTRA LRG & XL DEEP", "code_information": [{"code": "3.820.141S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 128.32, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 138.69, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"minimum": 80.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION DRUG DLVR IMPLANT", "code_information": [{"code": "11981", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 146.52, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 243.31, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 243.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 161.26, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1716.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2165.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 213.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 213.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 116.34, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 190.5, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "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": 384.48, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 932.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF SPINAL NEUROSTIMULATOR 63685", "code_information": [{"code": "63685", "type": "CPT"}, {"code": "1481152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 421.04, "maximum": 10180.0, "gross_charge": 6771.0, "discounted_cash": 38581.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2708.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4062.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4401.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 421.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF WIRE OR PIN W/ APPLICATION SKELETAL TRACTION LOWER EXTREMITY 20650", "code_information": [{"code": "20650", "type": "CPT"}, {"code": "1479969", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 4090.98, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 329.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OR REPLACE CRANIAL NEUROSTIM. GEN. DIRECT/INDUCTIVE SINGLE ELECTRODE 61885", "code_information": [{"code": "61885", "type": "CPT"}, {"code": "1481156", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 10032.0, "gross_charge": 4737.0, "discounted_cash": 38581.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 714.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION PALATE PROSTHESIS", "code_information": [{"code": "42281", "type": "CPT"}], "standard_charges": [{"minimum": 320.15, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER 36569", "code_information": [{"code": "36569", "type": "CPT"}, {"code": "1481157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 115.16, "maximum": 4936.0, "gross_charge": 1151.0, "discounted_cash": 1968.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 460.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 690.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 748.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 115.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88364", "type": "CPT"}], "standard_charges": [{"minimum": 84.78, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 91.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 84.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88365", "type": "CPT"}], "standard_charges": [{"minimum": 129.15, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 141.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 141.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 141.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 141.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 104.72, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 104.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 271.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION AUTO", "code_information": [{"code": "88367", "type": "CPT"}], "standard_charges": [{"minimum": 97.02, "maximum": 584.01, "discounted_cash": 448.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 252.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 233.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION MANUAL", "code_information": [{"code": "88368", "type": "CPT"}], "standard_charges": [{"minimum": 138.43, "maximum": 584.01, "discounted_cash": 448.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 203.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 203.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 219.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 203.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 203.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ ANT SGM AQ DRG DEV 1+", "code_information": [{"code": "671T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 803.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 803.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 868.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 803.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BREAST IMPLT SM D MAST", "code_information": [{"code": "19340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10219.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8294.96, "discounted_cash": 5201.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8294.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 20580.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 411.66, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 545.94, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 545.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 411.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 55071.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 665.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 335.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 335.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 114.26, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"minimum": 483.89, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 483.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 482.35, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 482.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 52.17, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1313.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 276.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5263.89, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5263.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 533.06, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 533.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT BRST IMPLT SEP D", "code_information": [{"code": "19342", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 10219.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 14067.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 24255.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 599.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 437.19, "maximum": 14067.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 437.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 466.5, "maximum": 14067.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 466.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 420.66, "maximum": 14067.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 420.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1283.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 913.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTILL PHARM RENAL PELVIS", "code_information": [{"code": "C9789", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 1477.0, "discounted_cash": 1530.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTLJ FECAL MICROBIOTA SSP", "code_information": [{"code": "780T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 170.88, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTRUMENT BODY CEMENT CANNULA INTRODUCER 1472-02", "code_information": [{"code": "1472-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT GRSPR 5MM X 35 CM 20MM JAW LAP DIRECT DRIVE EPIX DISP", "code_information": [{"code": "C4130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.34, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT HANDPIECE W/ HIGH FLOW TIP AND SUCTION TUBEINTERPULSE", "code_information": [{"code": "210-114-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.87, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT INTRACEPT ACCESS 2 VB RLV0045", "code_information": [{"code": "RLV0045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT JAW SMALL LIGASURE STERIL LF1212A", "code_information": [{"code": "LF1212A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.97, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT LIGASURE IMPACT OPEN TISS LF4418", "code_information": [{"code": "LF4418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2650.68, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT NAV G1 FLUTED MATCH 3MM 451611057", "code_information": [{"code": "451611057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.66, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT OBTURATOR 11MM W/ 5 MM PLUS SEAL VERSAPORT PLUS", "code_information": [{"code": "179102P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.97, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PATIENT REF PIN 4X175 451611036", "code_information": [{"code": "451611036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.33, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT PEANUT 5MM ENDO", "code_information": [{"code": "173019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SEALING 10MM VESSEL HND CONTROL LIGASURE", "code_information": [{"code": "LS1037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1488.46, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SPINE ARRAY BASE SET 451611021", "code_information": [{"code": "451611021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3030.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SPINE SINGLE INST ARRAY 4 451611022", "code_information": [{"code": "451611022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 833.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SUCTION FRAZIER BARON 12FR 0033120", "code_information": [{"code": "33120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.27, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SUCTION FRAZIER BARON 8FR 0033080", "code_information": [{"code": "33080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.71, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT TIP CAPS SELF-RETAINING RETRACTOR ORANGE TINT 1IN X 1.25IN (BECKMAN-ADSON RETRACTOR)", "code_information": [{"code": "3/9/2009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT VELYS SPINE SINGLE INST ARRAY 5 451611023", "code_information": [{"code": "451611023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 833.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODIES", "code_information": [{"code": "86337", "type": "CPT"}], "standard_charges": [{"minimum": 19.27, "maximum": 584.01, "discounted_cash": 27.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN ASPART 100UN/ML MDV 10 ML 966101", "code_information": [{"code": "966101", "type": "CDM"}], "standard_charges": [{"gross_charge": 268.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 149.05, "maximum": 584.01, "discounted_cash": 215.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 269.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 186.34, "maximum": 584.01, "discounted_cash": 370.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 186.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 186.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 201.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 186.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 186.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 92.7, "maximum": 584.01, "discounted_cash": 133.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 205.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 1 HROID W/O IMG", "code_information": [{"code": "46945", "type": "CPT"}], "standard_charges": [{"minimum": 463.93, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 463.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 588.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA BMWD", "code_information": [{"code": "Q4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRT OR OMNIGRAFT", "code_information": [{"code": "Q4105", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS BEHAVE THER CARDIO DX", "code_information": [{"code": "G0446", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.58, "maximum": 46.58, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.33, "maximum": 179.33, "discounted_cash": 161.17, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.33, "maximum": 179.33, "discounted_cash": 161.17, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY TRABECULAR METAL 11MM X 26MM X 10MM", "code_information": [{"code": "6-701-04101", "type": "CDM"}], "standard_charges": [{"gross_charge": 8808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8663.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 857.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL FIXATION", "code_information": [{"code": "21110", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1157.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 951.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 346.24, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 346.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERLINK EXTENSION SET 2 INJSITES 20\" 2C6606", "code_information": [{"code": "2C6606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 35.29, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL NEUROLYSIS REQUIRING USE OF OPERATING MICROSCOPE 64727", "code_information": [{"code": "64727", "type": "CPT"}, {"code": "1792998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 198.59, "maximum": 4936.0, "gross_charge": 1013.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 198.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICDS SS IP", "code_information": [{"code": "576T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 16.46, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 41.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 26.12, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 34.48, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 28.04, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG W/O PRGRMG IPNSS", "code_information": [{"code": "93153", "type": "CPT"}], "standard_charges": [{"minimum": 77.48, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 77.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS", "code_information": [{"code": "93151", "type": "CPT"}], "standard_charges": [{"minimum": 126.25, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS POLYSM", "code_information": [{"code": "93152", "type": "CPT"}], "standard_charges": [{"minimum": 196.14, "maximum": 584.01, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS DEV", "code_information": [{"code": "272T", "type": "CPT"}], "standard_charges": [{"minimum": 272.64, "maximum": 294.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS W/PGRMG", "code_information": [{"code": "273T", "type": "CPT"}], "standard_charges": [{"minimum": 272.64, "maximum": 294.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 39.3, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 71.64, "maximum": 1270.0, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 103.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 103.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 103.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4418.37, "maximum": 14116.01, "discounted_cash": 8486.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9316.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9316.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14116.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12367.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8148.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6955.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4418.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8408.74, "maximum": 18489.15, "discounted_cash": 16874.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12202.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12202.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18489.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16198.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10673.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9110.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8408.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3125.89, "maximum": 12085.67, "discounted_cash": 6403.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7976.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7976.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12085.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10588.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6976.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5955.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3125.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1659.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1307.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.5 CM/<", "code_information": [{"code": "12051", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.6-5.0 CM", "code_information": [{"code": "12052", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 415.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 823.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 5.1-7.5 CM", "code_information": [{"code": "12053", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 479.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 518.49, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 856.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT >30.0CM", "code_information": [{"code": "12047", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 798.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT12.6-20", "code_information": [{"code": "12045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 598.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [{"code": "12044", "type": "CPT"}], "standard_charges": [{"minimum": 514.49, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 12.6-20", "code_information": [{"code": "12035", "type": "CPT"}], "standard_charges": [{"minimum": 546.72, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT 7.6-12.5", "code_information": [{"code": "12034", "type": "CPT"}], "standard_charges": [{"minimum": 444.41, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 444.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT >30.0 CM", "code_information": [{"code": "12037", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 705.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 92.72, "maximum": 3347.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 92.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 92.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 92.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 75.9, "maximum": 3347.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 151.48, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 151.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACARDIAC ECG (ICE)", "code_information": [{"code": "93662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1751.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1616.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL COMPLETE STUDY", "code_information": [{"code": "93886", "type": "CPT"}], "standard_charges": [{"minimum": 294.11, "maximum": 605.62, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 560.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 560.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 605.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 560.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 294.11, "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": 4538.42, "maximum": 12407.77, "discounted_cash": 9033.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8189.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8189.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12407.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10870.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7162.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6114.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4538.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8877.8, "maximum": 21484.41, "discounted_cash": 17981.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14179.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14179.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21484.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18823.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12402.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10586.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8877.8, "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": 3071.88, "maximum": 9719.47, "discounted_cash": 6119.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6414.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6414.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9719.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8515.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5610.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4789.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3071.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 175.64, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 322.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 322.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 347.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 322.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.64, "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": 24668.34, "maximum": 92254.41, "discounted_cash": 47333.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60888.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60888.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92254.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80827.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53254.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 45460.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24668.34, "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": 35976.69, "maximum": 106090.98, "discounted_cash": 70357.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 70020.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 70020.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106090.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 92950.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 61242.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 52278.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 35976.69, "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": 15756.18, "maximum": 77201.0, "discounted_cash": 28410.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50953.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50953.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77201.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67638.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44565.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 38042.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15756.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2791.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3451.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5359.67, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5359.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2686.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4374.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAFRACTION TRACK MOTION", "code_information": [{"code": "G6017", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.61, "maximum": 156.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 156.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL BIOPSY", "code_information": [{"code": "30100", "type": "CPT"}], "standard_charges": [{"minimum": 186.9, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7446.96, "maximum": 51046.13, "discounted_cash": 16166.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33690.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33690.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51046.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44723.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29466.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 25154.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7446.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4813.79, "maximum": 11481.39, "discounted_cash": 9700.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7577.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7577.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11481.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10059.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6627.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5657.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4813.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 198.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 198.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"minimum": 433.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST CAVITY", "code_information": [{"code": "353T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOPERATIVE NEUROPHYSIOLOGY TESTING 95920", "code_information": [{"code": "1618455", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 397.98, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 744.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 397.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 112.02, "maximum": 3347.0, "discounted_cash": 9751.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANTIBODY", "code_information": [{"code": "86340", "type": "CPT"}], "standard_charges": [{"minimum": 13.57, "maximum": 584.01, "discounted_cash": 19.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM EST PATIENT", "code_information": [{"code": "92012", "type": "CPT"}], "standard_charges": [{"minimum": 122.14, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 161.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 161.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 174.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 161.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM NEW PATIENT", "code_information": [{"code": "92002", "type": "CPT"}], "standard_charges": [{"minimum": 114.7, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 166.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1569.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6308.97, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6308.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 22.41, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 656.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1543.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "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": 284.4, "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": 1829.37, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER KYPHON EXPRESS SZ 2 OID TROCAR", "code_information": [{"code": "T34B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.86, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER PERCUTANEOUS AP0716GW2", "code_information": [{"code": "AP0716GW2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SURG 10MM 2MM 1ST FIX TRAY KPHPK XPR", "code_information": [{"code": "KPE1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11074.65, "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": 284.4, "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": 28.98, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7MM X 15FR ENDO COUDE TIP", "code_information": [{"code": "9-0212-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.02, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1175.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 223.97, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INVISISHEILD POUCH 2-POCKET DYNJSD1018Z", "code_information": [{"code": "DYNJSD1018Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "IO ALLOGRAFT FOR SPINE SX ONLY STRUCTURAL 20931", "code_information": [{"code": "20931", "type": "CPT"}, {"code": "1643971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 125.86, "maximum": 8663.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8663.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 54.31, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 93.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 57.55, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 84.93, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 101.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 101.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 109.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 101.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 84.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO MAP OF SENT LYMPH NODE", "code_information": [{"code": "38900", "type": "CPT"}], "standard_charges": [{"minimum": 190.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 9208.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 9208.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 367.39, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 400.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 400.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 432.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 400.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 400.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IONM REMOTE/>1 PT OR PER HR", "code_information": [{"code": "95941", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOPAMIDOL 41% /ISOVUE M200 20ML", "code_information": [{"code": "MED0101", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 61.44, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 41%/ISOVUE M200 10ML VIAL", "code_information": [{"code": "MED0100", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.31, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 61%/ ISOVUE 300 50ML", "code_information": [{"code": "MED0103", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.17, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPAMIDOL 61%/ISOVUE 300 100ML", "code_information": [{"code": "MED0102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.98, "setting": "both", "billing_class": "facility"}]}, {"description": "IOPIDINE 0.5% OPHTHALMIC 5ML", "code_information": [{"code": "MED0105", "type": "CDM"}], "standard_charges": [{"gross_charge": 133.53, "setting": "both", "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST LOW 45", "code_information": [{"code": "99253", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST MOD 60", "code_information": [{"code": "99254", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST HI 80", "code_information": [{"code": "99255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST SF 35", "code_information": [{"code": "99252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Asp &/or Inj Major Jt or Bursa 20610", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "1748400", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 91.24, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Discography Lumbar 72295", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "1171978", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 68.86, "maximum": 584.01, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 68.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 68.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 74.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 68.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 68.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUMORS OPEN", "code_information": [{"code": "601T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 6.19, "maximum": 584.01, "discounted_cash": 8.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRR SOL SODIUM CHLORIDE 0.9% 500 ML", "code_information": [{"code": "2F7123", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.14, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIG DRUG DELIVERY DEVICE", "code_information": [{"code": "96523", "type": "CPT"}], "standard_charges": [{"minimum": 34.15, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 47.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION MAXILLARY SINUS", "code_information": [{"code": "31000", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDER", "code_information": [{"code": "51700", "type": "CPT"}], "standard_charges": [{"minimum": 103.78, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 103.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SPHENOID SINUS", "code_information": [{"code": "31002", "type": "CPT"}], "standard_charges": [{"minimum": 224.32, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRISEPT WOUND DEBRIDEMENT CLEANSING SYSTEM IRCEPT450USA", "code_information": [{"code": "IRCEPT450USA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 262.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [{"code": "62", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7948.16, "maximum": 28749.58, "discounted_cash": 15711.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18974.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18974.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28749.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25188.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16596.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14166.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7948.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [{"code": "61", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12065.27, "maximum": 35157.19, "discounted_cash": 24652.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23204.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23204.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35157.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30802.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20294.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17324.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12065.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC", "code_information": [{"code": "63", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6269.62, "maximum": 25660.71, "discounted_cash": 12551.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16936.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16936.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25660.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22482.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14812.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12644.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6269.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP GRAFT", "code_information": [{"code": "15740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": 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{"description": "Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use", "code_information": [{"code": "90638", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 40 mcg/0.4 mL dosage, for intramuscular use", "code_information": [{"code": "90613", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Iv cipaglucosidase alfa-atga", "code_information": [{"code": "G0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.45, "maximum": 257.45, "discounted_cash": 796.08, "setting": "outpatient", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 168.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 168.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 82.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 82.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQ ALYS", "code_information": [{"code": "27U", "type": "CPT"}], "standard_charges": [{"minimum": 121.91, "maximum": 219.76, "discounted_cash": 158.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 219.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 121.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 121.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81279", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 584.01, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29804", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 727.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JK GNOTYP SLC14A1 EXON 9", "code_information": [{"code": "192U", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 401.25, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOHN CUNNINGHAM ANTIBODY", "code_information": [{"code": "86711", "type": "CPT"}], "standard_charges": [{"minimum": 15.2, "maximum": 584.01, "discounted_cash": 21.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT SURVEY SINGLE VIEW", "code_information": [{"code": "77077", "type": "CPT"}], "standard_charges": [{"minimum": 28.49, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"minimum": 254.59, "maximum": 413.0, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 344.36, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 398.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 344.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 141.03, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 141.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 141.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 152.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 141.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 141.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 217.31, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 247.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 228.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 217.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KEL GNOTYP KEL EXON 8", "code_information": [{"code": "194U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KENALOG 40/ TRIAMCINOLONE ACETONIDE 40 MG/ML", "code_information": [{"code": "MED0106", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KENDALL SCD EXPRESS COMPRESSION SLEEVE KNEE LENGTH MEDIUM", "code_information": [{"code": "9529R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.1, "setting": "both", "billing_class": "facility"}]}, {"description": "KERAMATRIX, KERASORB SQ CM", "code_information": [{"code": "Q4165", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee 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"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24087.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21103.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13904.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11869.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6712.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [{"code": "660", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5980.42, "maximum": 18354.25, "discounted_cash": 11817.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12113.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12113.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18354.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16080.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10595.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9044.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5980.42, "methodology": "case 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rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20724.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11533.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "661", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4581.72, "maximum": 13606.7, "discounted_cash": 9257.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8980.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8980.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13606.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11921.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7854.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6705.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4581.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [{"code": "689", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4855.27, "maximum": 9852.99, "discounted_cash": 10374.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6503.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6503.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9852.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8632.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5687.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4855.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5223.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [{"code": "690", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2913.98, "maximum": 5913.44, "discounted_cash": 7238.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3902.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3902.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5913.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5180.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3413.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2913.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3582.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [{"code": "687", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4698.2, "maximum": 14834.54, "discounted_cash": 9368.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9790.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9790.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14834.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12997.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8563.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7310.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4698.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [{"code": "686", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8415.88, "maximum": 21580.77, "discounted_cash": 16127.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14243.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14243.46, "methodology": "case rate"}, {"payer_name": "BLUE 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CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8920.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8920.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13515.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11841.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7802.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6660.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3232.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "695", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5033.37, "maximum": 19492.62, "discounted_cash": 10227.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12865.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12865.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19492.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17078.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11252.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9605.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5033.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3087.5, "maximum": 6852.22, "discounted_cash": 6160.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4522.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4522.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6852.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6003.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3955.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3376.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3087.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 505.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50553", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 540.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 582.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50572", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 629.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 843.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50555", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50574", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 586.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 664.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 666.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee 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combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 107.86, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 121.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY HISTOTRIPSY W/IMAGE", "code_information": [{"code": "C9790", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 2105.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 173.98, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 202.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 234.4, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 235.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT", "code_information": [{"code": "652", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20792.61, "maximum": 42195.23, "discounted_cash": 28876.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27849.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27849.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42195.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36968.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24357.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20792.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30612.36, "maximum": 62122.82, "discounted_cash": 42036.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41001.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41001.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62122.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 54427.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 35861.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 30612.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [{"code": "651", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25053.69, "maximum": 50842.4, "discounted_cash": 33134.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33556.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33556.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50842.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44544.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29349.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 25053.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIT ABLATION  RF-0510L-01", "code_information": [{"code": "RF-0510L-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23028.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY MULTI LEAD TRIALING CABLE", "code_information": [{"code": "3555531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY NEUROLOGICAL ASCENDA INTRATHECAL ANCHOR TOOL", "code_information": [{"code": "8785", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1034.24, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACM W / FEMORAL BREAKAWAY NOZZLE &PROX 0306-573-000", "code_information": [{"code": "306-573-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.43, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSION 0657M2156141", "code_information": [{"code": "657M2156141", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 243.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSION ADM215614D", "code_information": [{"code": "ADM215614D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 243.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSIONS", "code_information": [{"code": "657M215614A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 243.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSIONS ADM215614E", "code_information": [{"code": "ADM215614E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6082.22, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSIONS CUSTOM BXTDM2156144", "code_information": [{"code": "BXTDM2156144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.77, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ADMISSIONS CUSTOM(USPI) BXTDM2156146", "code_information": [{"code": "BXTDM2156146", "type": "CDM"}], "standard_charges": [{"gross_charge": 2291.21, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANCHOR STERILEM365SC43180", "code_information": [{"code": "M365SC43180", "type": "CDM"}], "standard_charges": [{"gross_charge": 1212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BALLON ARCADIA STEERABLE  ARC25SB-LK", "code_information": [{"code": "ARC25SB-LK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13029.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE GRAFT LARGE II INFUSE", "code_information": [{"code": "7510800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23876.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE TAMP AF 10/2", "code_information": [{"code": "KEX102NB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7832.79, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE TAMP FF E2 20/2", "code_information": [{"code": "KEX202EB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11120.91, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATHETER CV 18GA 7FR X 20CM MULTI-LUMEN BLUE FLEXTIP", "code_information": [{"code": "AK-15703-SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.99, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATHETER RADIAL ARTERY 20GX1 3 4 RA-04020", "code_information": [{"code": "RA-04020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATHETER TEGADERM DOUBLE LUMEN 7FR 20CM CDC-46702-XP1A", "code_information": [{"code": "CDC-46702-XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.93, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATHETERIZATION ARTERIAL 18G X 6 HUDSK04018UPM", "code_information": [{"code": 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13CM", "code_information": [{"code": "AK-14402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.43, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE SITE CLOSURE 2 PIECE", "code_information": [{"code": "PMI12", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 57.96, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE SITE CLOSURE 3 PIECE", "code_information": [{"code": "PMI512", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 65.27, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRAIN 100CC 3/4 PERFORATED BULB FLAT RESERVOIR SILICONE", "code_information": [{"code": "71360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.43, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EMERGENCY CRICOTHYROIDOTOMY 100/465/060", "code_information": [{"code": "100/465/060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EVACTOR 3 SPRNG 400 CC DRAIN 1/8 0043610", "code_information": [{"code": "43610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.66, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EVACUATOR 3 SPRNG 400 CC DRAIN 0043600", "code_information": [{"code": "43600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.27, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 110IN 37IN BREATHING CIRCUIT UNIVERSAL FLEX2", "code_information": [{"code": "XF37", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.86, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EXTENSION 60IN CIRCUIT SNGL LIMB UNIVERSAL LF", "code_information": [{"code": "XF60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.71, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FREELINK REMOTE CONTROL", "code_information": [{"code": "SC-5552-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3232.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GELATIN POWDER ABSORBL SURGIFOAM LF", "code_information": [{"code": "1979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.35, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GENE ANALYS D816 VARIANT", "code_information": [{"code": "81273", "type": "CPT"}], "standard_charges": [{"minimum": 112.38, "maximum": 584.01, "discounted_cash": 162.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 168.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 168.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 182.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 168.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 168.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 112.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 112.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT GENE TARGETED SEQ ANALYS", "code_information": [{"code": "81272", "type": "CPT"}], "standard_charges": [{"minimum": 296.56, "maximum": 584.01, "discounted_cash": 428.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 481.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT GWN STANDARD WARMING FLEX GOWN BOOTIES BONNET PERSONAL BELONGINGS BAG AND SH", "code_information": [{"code": "84003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INFUSER PAIN PUMP SMART", "code_information": [{"code": "418108400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INFUSER PAIN PUMP SMART 200ML", "code_information": [{"code": "418108200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START STERILE 3434-1", "code_information": [{"code": "3434-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.24, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START TEGADERM GAUZE SPONGE ALCOHOL PREP SYNTHETIC TOURNIQUET DRAPE 3/4 X 18IN", "code_information": [{"code": "1-1900A", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.34, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV START W/TEGADERM CHG", "code_information": [{"code": "50198", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.21, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LONG VERTEBROPLASTY  VP-1110L", "code_information": [{"code": "VP-1110L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5777.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MEDIUM COMPLEXITY", "code_information": [{"code": "18243", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.88, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MTRX 6CC HEMOSTATIC W/ PREFILLED SYRNG OF HEMOSTATIC MATRIX WHT APPLICATOR T", "code_information": [{"code": "1991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2119.91, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ORTHOPEDIC FRACTURE SPK10183", "code_information": [{"code": "SPK10183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT CARE HANA PROFX", "code_information": [{"code": "6855", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.37, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT POSITIONING PRO FX", "code_information": [{"code": "PFXH1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.41, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PATIENT TRIAL SC-6500-72 SC-6500-72", "code_information": [{"code": "SC-6500-72", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PNEUMOTHORAX 8FR CATH SAFETY AK-01500", "code_information": [{"code": "AK-01500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 721.14, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PRECISION CHARGING SYSTEM BUNDLE SC-1495M", "code_information": [{"code": "SC-1495M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PRESSURE MNTR W TRANSDUCER 72", "code_information": [{"code": "42652-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 148.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PRESSURE MONITORING 84", "code_information": [{"code": "DYNJTRANS84", "type": "CDM"}], "standard_charges": [{"gross_charge": 52.34, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT REMOTE CONTROL", "code_information": [{"code": "SC5532-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOL 6 ML SKIN SURG PREP W/ APPLICATOR DURAPREP STRL", "code_information": [{"code": "8635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.33, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SOLN 26 ML SKIN SURG PREP W/ APPLICATOR 3M HEATHCARE DURAPREP LF STRL", "code_information": [{"code": "8630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.05, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPLITTER 2 X 8 30 CM", "code_information": [{"code": "SC-3400-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7554.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STIMULATION SPINAL CORD PATIENT TRIAL PRECISION SPECTRA", "code_information": [{"code": "SC-6500-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STYLT 30CM 50CM 70CM AUDITORY BRAINSTEM W/ STEERING CAP AND STIFFER STYLET A", "code_information": [{"code": "SC-4395-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.72, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SURGICAL LEAD 4 X 8 50CM", "code_information": [{"code": "CS-8336-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRIAL PATIENT ETS BELT ETS BATTERY", "code_information": [{"code": "SC-6500-03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.24, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TUNNELER", "code_information": [{"code": "SC-4252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT UNIVERSAL F2 BREATHING CIRCUITS LF", "code_information": [{"code": "F94474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KLF1 TARGETED SEQUENCING", "code_information": [{"code": "195U", "type": "CPT"}], "standard_charges": [{"minimum": 337.73, "maximum": 547.87, "discounted_cash": 487.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 547.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 506.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY DX", "code_information": [{"code": "29870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/DRAINAGE", "code_information": [{"code": "29871", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 648.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 782.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29851", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1136.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29873", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 687.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29874", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 668.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29875", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29876", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29877", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 774.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29879", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 822.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 704.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29881", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 681.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 849.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29883", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1037.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29884", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 773.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29885", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 939.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29886", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 797.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29887", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29888", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1177.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29889", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1494.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROTOMY W/EXPLORATION 27310", "code_information": [{"code": "27310", "type": "CPT"}, {"code": "1481182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 4090.98, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 909.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ORTHOSIS ELASTIC WITH JOINT", "code_information": [{"code": "L1812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9465.58, "maximum": 20048.72, "discounted_cash": 18697.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13232.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13232.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20048.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17565.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11573.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9879.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9465.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [{"code": "485", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14367.74, "maximum": 34767.64, "discounted_cash": 28854.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22946.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22946.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34767.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30461.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20070.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17132.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14367.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "487", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7052.43, "maximum": 15815.99, "discounted_cash": 14003.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10438.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10438.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15815.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13856.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9129.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7793.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7052.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8771.58, "maximum": 27231.3, "discounted_cash": 15816.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17972.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17972.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27231.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23858.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15719.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13418.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8771.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5526.98, "maximum": 19195.29, "discounted_cash": 9985.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12669.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12669.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19195.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16817.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11080.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9458.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5526.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNIFE BAYONET DISP", "code_information": [{"code": "1564-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1262.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE HANDLE KNIFE STANDARD BAYONETINSTR", "code_information": [{"code": "1563-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1262.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KRAS GENE ADDL VARIANTS", "code_information": [{"code": "81276", "type": "CPT"}], "standard_charges": [{"minimum": 173.93, "maximum": 584.01, "discounted_cash": 251.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 287.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KRAS GENE VARIANTS EXON 2", "code_information": [{"code": "81275", "type": "CPT"}], "standard_charges": [{"minimum": 173.93, "maximum": 584.01, "discounted_cash": 251.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 266.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 266.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 288.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 266.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 266.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2524.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2907.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44207", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2184.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2386.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 998.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ARTERY/VENTRICLE ANGIO", "code_information": [{"code": "93458", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT CATH TRNSPTL PUNCTURE", "code_information": [{"code": "93462", "type": "CPT"}], "standard_charges": [{"minimum": 267.17, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 267.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7526", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 518.43, "maximum": 9225.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 19.79, "maximum": 584.01, "discounted_cash": 28.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATE (LD) (LDH) ENZYME", "code_information": [{"code": "83615", "type": "CPT"}], "standard_charges": [{"minimum": 5.44, "maximum": 584.01, "discounted_cash": 7.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATED RINGER'S INJECTION USP 500 mL", "code_information": [{"code": "759303", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 17.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATED RINGERS 1000ML BAG", "code_information": [{"code": "409-7953-09", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUAL)", "code_information": [{"code": "83630", "type": "CPT"}], "standard_charges": [{"minimum": 17.73, "maximum": 584.01, "discounted_cash": 25.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUANT)", "code_information": [{"code": "83631", "type": "CPT"}], "standard_charges": [{"minimum": 17.67, "maximum": 584.01, "discounted_cash": 25.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV VACC PANDEMIC INTRANASL", "code_information": [{"code": "90664", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV3 VACCINE INTRANASAL", "code_information": [{"code": "90660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV4 VACCINE INTRANASAL", "code_information": [{"code": "90672", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAM W/CORDOTOMY 1STG THRC", "code_information": [{"code": "63197", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2132.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 17.39, "maximum": 584.01, "discounted_cash": 25.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMELLAS XT, PER SQ CM", "code_information": [{"code": "Q4291", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMELLAS, PER SQ CM", "code_information": [{"code": "Q4292", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY CERVICAL 1 -2 SEGMENTS 63001", "code_information": [{"code": "63001", "type": "CPT"}, {"code": "1481185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1524.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY CERVICAL 3 OR MORE SEGMENTS 63015", "code_information": [{"code": "63015", "type": "CPT"}, {"code": "1481186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1841.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXC.INTRASPINAL NEOPLASM INTRADURAL INTRAMEDULLARY THORACOLUMBAR 63287", "code_information": [{"code": "63287", "type": "CPT"}, {"code": "1481187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3337.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY CERVICAL 63280", "code_information": [{"code": "63280", "type": "CPT"}, {"code": "1481189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2612.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY LUMBAR 63282", "code_information": [{"code": "63282", "type": "CPT"}, {"code": "1481190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2455.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL EXTRAMEDULLARY THORACIC 63281", "code_information": [{"code": "63281", "type": "CPT"}, {"code": "1481191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2591.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXCISION INTRASPINAL NEOPLASM;INTRADURAL SACRAL 63283", "code_information": [{"code": "63283", "type": "CPT"}, {"code": "1481194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2371.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACECTOMY UNI DURING POST. ARTHRODESIS LUMBAR 63052", "code_information": [{"code": "63052", "type": "CPT"}, {"code": "45999708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 295.18, "maximum": 6887.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 295.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FACECTOMY UNI. 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SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 266.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY W/DECOMP.OF NERVE ROOTS W/EXCISION OF HERNIATED DISC/LUMBAR 63030", "code_information": [{"code": "63030", "type": "CPT"}, {"code": "1481221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "estimated_discounted_cash": 17090.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1159.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY/HEMILAMINECTOMY DISCECTOMY CERVICAL 63020", "code_information": [{"code": "63020", "type": "CPT"}, {"code": "1481222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1373.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANCET BLOOD SAMPLE SAFETY LOW FLOW NEEDLE 28GA", "code_information": [{"code": "SLLF100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.69, "setting": "both", "billing_class": "facility"}]}, {"description": "LANGUAGE SCREENING", "code_information": [{"code": "V5363", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANTERN SURGICAL ASSISTANT KNEE-TOTAL 406000", "code_information": [{"code": "406000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4019.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP CLOSE ENTEROSTOMY", "code_information": [{"code": "44227", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2002.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1619.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2591.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1501.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ENTERECTOMY", "code_information": [{"code": "44202", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1689.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ENTEROLYSIS", "code_information": [{"code": "44180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1130.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 185.61, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 1104.19, "maximum": 1104.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2241.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2109.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1356.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR INIT", "code_information": [{"code": "49650", "type": "CPT"}], "standard_charges": [{"minimum": 553.99, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 553.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR RECUR", "code_information": [{"code": "49651", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 152.03, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"minimum": 477.99, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 477.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 817.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL ADD-ON", "code_information": [{"code": "44213", "type": "CPT"}], "standard_charges": [{"minimum": 218.68, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1567.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2090.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN REPAIR", "code_information": [{"code": "43281", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1860.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2107.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PLACE GASTR ADJ DEVICE", "code_information": [{"code": "43770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1393.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1848.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2281.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2391.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2590.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1571.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 283.06, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1571.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"minimum": 507.76, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 507.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ ALL PARTS", "code_information": [{"code": "43774", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1183.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ DEVICE", "code_information": [{"code": "43772", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1168.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP SLEEVE GASTRECTOMY", "code_information": [{"code": "43775", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1303.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"minimum": 220.78, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 220.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1541.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1533.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL CYST", "code_information": [{"code": "50541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL MASS", "code_information": [{"code": "50542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1412.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/EXPLR", "code_information": [{"code": "47564", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4028.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1385.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/GRAPH", "code_information": [{"code": "47563", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4028.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 893.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4028.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 960.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO LIGATE SPERMATIC VEIN", "code_information": [{"code": "55550", "type": "CPT"}], "standard_charges": [{"minimum": 534.58, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1667.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1530.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1862.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1797.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1605.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2017.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4028.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1611.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO SLING OPERATION", "code_information": [{"code": "51992", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2163.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2480.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO-ASST VAG HYSTERECTOMY", "code_information": [{"code": "58550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1048.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1308.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST COMPLEX", "code_information": [{"code": "58553", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST INCL T/O", "code_information": [{"code": "58552", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1168.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST W/T/O COMPL", "code_information": [{"code": "58554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1547.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY", "code_information": [{"code": "47562", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 825.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7401.44, "maximum": 25399.18, "discounted_cash": 15125.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16763.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16763.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25399.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22253.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14661.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12515.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7401.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10606.32, "maximum": 30478.46, "discounted_cash": 21337.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20116.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20116.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30478.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26703.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17594.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15018.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10606.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5880.45, "maximum": 14637.7, "discounted_cash": 12212.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9660.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9660.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14637.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12824.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8449.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7213.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5880.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY", "code_information": [{"code": "58545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1074.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC NEPHRECTOMY", "code_information": [{"code": "50546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1454.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1453.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY APPENDECTOMY", "code_information": [{"code": "44970", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ASPIRATION", "code_information": [{"code": "49322", "type": "CPT"}], "standard_charges": [{"minimum": 466.07, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 466.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY BIOPSY", "code_information": [{"code": "49321", "type": "CPT"}], "standard_charges": [{"minimum": 432.34, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 432.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY EXCISE LESIONS", "code_information": [{"code": "58662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 860.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FUNDOPLASTY", "code_information": [{"code": "43280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1320.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 738.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.11, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 937.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPH NODE BIOP", "code_information": [{"code": "38570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 635.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 803.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYSIS", "code_information": [{"code": "58660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 829.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIECTOMY", "code_information": [{"code": "54690", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIOPEXY", "code_information": [{"code": "54692", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY PYELOPLASTY", "code_information": [{"code": "50544", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1493.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY REMOVE ADNEXA", "code_information": [{"code": "58661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 778.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SALPINGOSTOMY", "code_information": [{"code": "58673", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 934.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1306.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [{"code": "57425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1150.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL BLOCK", "code_information": [{"code": "58671", "type": "CPT"}], "standard_charges": [{"minimum": 443.47, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL CAUTERY", "code_information": [{"code": "58670", "type": "CPT"}], "standard_charges": [{"minimum": 443.47, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY URETEROLITHOTOMY", "code_information": [{"code": "50945", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 827.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 955.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"minimum": 1519.62, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1519.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPRO-SHARK FASCIAL CLOSURE DEVICE", "code_information": [{"code": "P10176", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 230.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 817.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 38581.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1426.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1463.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT SMPL STOT", "code_information": [{"code": "55867", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2344.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGE CAPACITY FORCEPS Large Capacity Biopsy Forceps  133-4667 Alligator Blue 230 2.8", "code_information": [{"code": "BF40286", "type": "CDM"}], "standard_charges": [{"gross_charge": 29.67, "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": 29.67, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 675.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1186.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 402.78, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 369.3, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 369.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 380.46, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 380.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYGOSCOPE GVL S3", "code_information": [{"code": "574-0100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.73, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYGOSCOPE GVL S4", "code_information": [{"code": "270-0628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.03, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 121.92, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 139.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 139.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 150.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 139.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1455.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1690.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1834.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1775.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2003.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2004.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1553.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1333.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 354.73, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 354.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/VC INJ + SCOPE", "code_information": [{"code": "31571", "type": "CPT"}], "standard_charges": [{"minimum": 284.58, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 284.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 457.55, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 457.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 43.98, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 203.12, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 279.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 279.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 301.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 279.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 203.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 167.59, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 167.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 185.44, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 303.83, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 303.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 224.2, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 224.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 259.4, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 259.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BIOPSY", "code_information": [{"code": "31535", "type": "CPT"}], "standard_charges": [{"minimum": 217.77, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 217.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BX & OP SCOPE", "code_information": [{"code": "31536", "type": "CPT"}], "standard_charges": [{"minimum": 241.06, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/EXC OF TUMOR", "code_information": [{"code": "31540", "type": "CPT"}], "standard_charges": [{"minimum": 276.47, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 244.51, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 232.12, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 232.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 285.49, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31576", "type": "CPT"}], "standard_charges": [{"minimum": 355.41, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 387.75, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 387.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP W/TUMR EXC + SCOPE", "code_information": [{"code": "31541", "type": "CPT"}], "standard_charges": [{"minimum": 300.76, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 300.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURG PENIS LESION(S)", "code_information": [{"code": "54057", "type": "CPT"}], "standard_charges": [{"minimum": 191.35, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY ANAL LESIONS", "code_information": [{"code": "46917", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 611.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 523.76, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 523.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"minimum": 259.68, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 259.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 712.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67039", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1099.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1181.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAT RETINACULAR RELEASE OPEN", "code_information": [{"code": "27425", "type": "CPT"}], "standard_charges": [{"minimum": 583.71, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 583.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LDR PROSTATE BRACHY COMP RAT", "code_information": [{"code": "G0458", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD SPECIFY 5 X 6 X 5 90CM SURE SCAN MRI PADDEL", "code_information": [{"code": "977C190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21412.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD SPINAL CHORD STIM BLANKS", "code_information": [{"code": "SC-4350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD TINED 1201", "code_information": [{"code": "1201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/ GRAFT", "code_information": [{"code": "21145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1864.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/O GRAFT", "code_information": [{"code": "21141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1618.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/ GRAFT", "code_information": [{"code": "21146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1947.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/O GRAFT", "code_information": [{"code": "21142", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1657.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2045.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/O GRAFT", "code_information": [{"code": "21143", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1705.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1899.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2086.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2486.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3217.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2970.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2247.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFT HRT CATH W/VENTRCLGRPHY", "code_information": [{"code": "93452", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 845.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1124.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 37.58, "maximum": 584.01, "discounted_cash": 54.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMOPHILIA AG IF", "code_information": [{"code": "87278", "type": "CPT"}], "standard_charges": [{"minimum": 14.04, "maximum": 584.01, "discounted_cash": 20.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA ANTIBODY", "code_information": [{"code": "86713", "type": "CPT"}], "standard_charges": [{"minimum": 13.77, "maximum": 584.01, "discounted_cash": 19.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 11.03, "maximum": 584.01, "discounted_cash": 15.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHEN METACARPAL/FINGER", "code_information": [{"code": "26568", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1199.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1363.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS OR ULNA", "code_information": [{"code": "25391", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1212.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND TENDON", "code_information": [{"code": "26478", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1112.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1032.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1807.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 630.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1085.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEPTOSPIRA ANTIBODY", "code_information": [{"code": "86720", "type": "CPT"}], "standard_charges": [{"minimum": 14.58, "maximum": 584.01, "discounted_cash": 21.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKACYTE TRANSFUSION", "code_information": [{"code": "86950", "type": "CPT"}], "standard_charges": [{"minimum": 64.71, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE ASSESSMENT FECAL", "code_information": [{"code": "89055", "type": "CPT"}], "standard_charges": [{"minimum": 3.84, "maximum": 584.01, "discounted_cash": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE HISTAMINE RELEASE", "code_information": [{"code": "86343", "type": "CPT"}], "standard_charges": [{"minimum": 11.21, "maximum": 584.01, "discounted_cash": 16.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE PHAGOCYTOSIS", "code_information": [{"code": "86344", "type": "CPT"}], "standard_charges": [{"minimum": 9.35, "maximum": 584.01, "discounted_cash": 13.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEEN/SHUNT PATENCY EXAM", "code_information": [{"code": "78291", "type": "CPT"}], "standard_charges": [{"minimum": 251.02, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 257.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 257.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 278.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 257.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 257.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 0.5% 50ML VIAL", "code_information": [{"code": "MED0109", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.17, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 20ML VIAL", "code_information": [{"code": "MED0113", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 30ML VIAL", "code_information": [{"code": "MED0114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.68, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% 50ML VIAL", "code_information": [{"code": "MED0115", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.93, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% INJ  SOLN 10 ML", "code_information": [{"code": "MED0112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% INJ 2ML", "code_information": [{"code": "MED0110", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 1% PF 5ML VIAL", "code_information": [{"code": "MED0111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.56, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 10ML VIAL", "code_information": [{"code": "MED0118", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 20ML VIAL", "code_information": [{"code": "MED0119", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.03, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 50ML VIAL", "code_information": [{"code": "MED0120", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% PF 5 ML VIAL", "code_information": [{"code": "MED0117", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% TOP JELLY 5 ML", "code_information": [{"code": "MED0122", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.07, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 2%/XYLOCAINE 2ML", "code_information": [{"code": "MED0116", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.72, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% PF INJ 5 ML", "code_information": [{"code": "MED0121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.03, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 0.5%-1:200,000 50ML VIAL", "code_information": [{"code": "MED0123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 10ML VIAL", "code_information": [{"code": "MED0124", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.94, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 20ML VIAL", "code_information": [{"code": "MED0125", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.36, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1% 30ML VIAL", "code_information": [{"code": "MED0126", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.12, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 1.5% PF INJ 30ML", "code_information": [{"code": "MED0127", "type": "CDM"}], "standard_charges": [{"gross_charge": 33.16, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 20ML VIAL", "code_information": [{"code": "MED0130", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 30ML VIAL", "code_information": [{"code": "MED0131", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% 50ML VIAL", "code_information": [{"code": "MED0220", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% DENTAL CARTRIDGE 1.7ML INJ", "code_information": [{"code": "MED0128", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.61, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPI 2% PF 10ML", "code_information": [{"code": "MED0129", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.88, "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": 1886.06, "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": 1993.42, "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": 1948.57, "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": 1928.88, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1851.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 638.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 691.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 87.26, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 442.65, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 442.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1834.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 554.36, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 554.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 474.39, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 474.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 721.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 453.75, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1582.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1403.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 484.56, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 484.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF HEMORRHOID(S)", "code_information": [{"code": "46221", "type": "CPT"}], "standard_charges": [{"minimum": 430.94, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 430.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2062.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 883.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 614.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 860.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 487.32, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 536.86, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 536.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1036.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGHT SOURCE 2762-01-004", "code_information": [{"code": "2762-01-004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.62, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SOURCE TEDAN 100-0035", "code_information": [{"code": "1100-0035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 90.01, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 141.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 244.88, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17059.37, "maximum": 117226.87, "discounted_cash": 33646.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77370.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77370.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 117226.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 102706.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 67670.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 57766.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17059.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88036", "type": "CPT"}], "standard_charges": [{"minimum": 93.22, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 93.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 93.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88037", "type": "CPT"}], "standard_charges": [{"minimum": 82.83, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 82.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 82.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED VISUAL FIELD XM", "code_information": [{"code": "92081", "type": "CPT"}], "standard_charges": [{"minimum": 23.46, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINE AUTOTRANSFUCION AUTOLOG ANTICOAGULATE STRL", "code_information": [{"code": "BT725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.44, "setting": "both", "billing_class": "facility"}]}, {"description": "LINE GAS SAMPLING 10FT .05 ID MM DYNJAA18", "code_information": [{"code": "DYNJAA18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.67, "setting": "both", "billing_class": "facility"}]}, {"description": "LINE GAS SAMPLING 10FT .06IN TRANSPARENT MALE MALE CONNECTORS", "code_information": [{"code": "DYNJAA04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LINE SAMPLG MALE-FEMALE 10FTX.50 ID GAS", "code_information": [{"code": "WHSA20MF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER CERAMIC 230HS UPCHARGE", "code_information": [{"code": "96-35-891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER FOAM 28OZ PITCHER", "code_information": [{"code": "MED 101", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.74, "setting": "both", "billing_class": "facility"}]}, {"description": "LIPOPRO BLD ELECTROPHORETIC", "code_information": [{"code": "83700", "type": "CPT"}], "standard_charges": [{"minimum": 10.13, "maximum": 584.01, "discounted_cash": 14.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD HR FRACTION", "code_information": [{"code": "83701", "type": "CPT"}], "standard_charges": [{"minimum": 30.47, "maximum": 584.01, "discounted_cash": 44.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD QUAN PART", "code_information": [{"code": "83704", "type": "CPT"}], "standard_charges": [{"minimum": 30.77, "maximum": 584.01, "discounted_cash": 44.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPRTN DIR MEAS SD LDL CHL", "code_information": [{"code": "83722", "type": "CPT"}], "standard_charges": [{"minimum": 30.77, "maximum": 584.01, "discounted_cash": 44.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 47.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIQUID ADHSV 2 ML X 3 ML SURG BANDAGE ADHSV TIP VIAL MASTISTOL LF STRL", "code_information": [{"code": "523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LIQUID MASTISOL 052348", "code_information": [{"code": "52348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES", "code_information": [{"code": "86723", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1699.58, "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": 7.35, "maximum": 584.01, "gross_charge": 107.0, "discounted_cash": 10.62, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 118.02, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 118.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER AND SPLEEN IMAGING", "code_information": [{"code": "78215", "type": "CPT"}], "standard_charges": [{"minimum": 203.31, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 210.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 210.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 227.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 210.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 210.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 203.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 453.06, "maximum": 734.96, "discounted_cash": 654.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 679.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 679.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 734.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 679.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 679.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}], "standard_charges": [{"minimum": 158.57, "maximum": 584.01, "discounted_cash": 229.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 25.83, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING", "code_information": [{"code": "78201", "type": "CPT"}], "standard_charges": [{"minimum": 198.92, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 204.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 204.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 221.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 204.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 204.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 198.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 221.26, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 239.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 81.59, "maximum": 3442.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 138.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 138.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 150.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 138.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 684.0, "discounted_cash": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [{"code": "496", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8805.5, "maximum": 30094.42, "discounted_cash": 16129.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19862.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19862.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30094.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26366.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17372.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14829.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8805.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [{"code": "495", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15712.44, "maximum": 57049.04, "discounted_cash": 32418.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37652.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37652.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57049.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49982.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32932.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 28112.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15712.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "497", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5992.02, "maximum": 27126.69, "discounted_cash": 10803.85, "estimated_discounted_cash": 32514.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17903.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17903.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27126.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23766.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15659.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13367.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5992.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC", "code_information": [{"code": "498", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11268.63, "maximum": 32168.81, "discounted_cash": 26974.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21231.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21231.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32168.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28184.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18569.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15851.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11268.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "499", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5180.65, "maximum": 24710.93, "discounted_cash": 18015.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16309.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16309.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24710.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21650.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14264.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12176.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5180.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCK ADAPTER MANIFOLD 3-PORT CHECK VALVES  BHL2C9282", "code_information": [{"code": "BHL2C9282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.38, "setting": "both", "billing_class": "facility"}]}, {"description": "LOCK SYRINGE STERILE LUER 10ML SYR110010Z", "code_information": [{"code": "SYR110010Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.13, "setting": "both", "billing_class": "facility"}]}, {"description": "LONG CHAIN FATTY ACIDS", "code_information": [{"code": "82726", "type": "CPT"}], "standard_charges": [{"minimum": 17.78, "maximum": 584.01, "discounted_cash": 25.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOOP VESSEL MINI RED MED GRADE SILICONE X RAY DETECT ELEMENT LF", "code_information": [{"code": "30712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.68, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC 11 X 14 X 11MM 7DEG  TRABECULAR METAL  06-101-02111", "code_information": [{"code": "6-101-02111", "type": "CDM"}], "standard_charges": [{"gross_charge": 3180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE ROI-C  CERVICAL  14X17 H8MM MC1434P", "code_information": [{"code": "MC1434P", "type": "CDM"}], "standard_charges": [{"gross_charge": 4100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 64.18, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 64.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 220.94, "maximum": 584.01, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 220.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 220.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 238.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 220.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 522.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "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": 10715.66, "maximum": 28638.08, "discounted_cash": 22676.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18901.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18901.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28638.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25090.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16531.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14112.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10715.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [{"code": "492", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15849.01, "maximum": 43205.58, "discounted_cash": 32829.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28516.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28516.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43205.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37853.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24940.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21290.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15849.01, "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": 8414.54, "maximum": 19549.05, "discounted_cash": 17940.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12902.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12902.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19549.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17127.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11284.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9633.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8414.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY STUDY", "code_information": [{"code": "93925", "type": "CPT"}], "standard_charges": [{"minimum": 262.42, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 262.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY STUDY", "code_information": [{"code": "93926", "type": "CPT"}], "standard_charges": [{"minimum": 153.57, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 209.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 209.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 226.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 209.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER JAW BONE GRAFT", "code_information": [{"code": "21215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5430.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 30.47, "maximum": 49.44, "discounted_cash": 44.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LR 3000ML BAG", "code_information": [{"code": "MED0270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 44.56, "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": 5445.68, "setting": "both", "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 867.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 990.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 979.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1070.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LT/RT STATIC AFO PRE-FAB CUSTOM FIT L4396", "code_information": [{"code": "L4396", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 586.45, "setting": "both", "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "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": 90.87, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY 120GM TUBE", "code_information": [{"code": "MED0133", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.4, "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, "setting": "both", "billing_class": "facility"}]}, {"description": "LUGOLS 30ML SOLUTION", "code_information": [{"code": "MED0134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 209.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR LAMINECTOMY PACK SNE21LLBWD", "code_information": [{"code": "SNE21LLBWD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.32, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PEEK INTERBODY 10MM X 32MM X 8MM  5 DEGREE  POROUS COATED P11032-508", "code_information": [{"code": "P11032-508", "type": "CDM"}], "standard_charges": [{"gross_charge": 9000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 17.77, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 296.82, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 356.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 192.1, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 206.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 206.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 223.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 206.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 206.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION IMAGING", "code_information": [{"code": "78580", "type": "CPT"}], "standard_charges": [{"minimum": 229.57, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 271.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 229.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5548.2, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5548.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3988.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3988.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4366.88, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4366.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5882.32, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5882.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 316.95, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 350.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 350.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 378.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 350.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 350.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1841.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 270.39, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86617", "type": "CPT"}], "standard_charges": [{"minimum": 13.94, "maximum": 584.01, "discounted_cash": 20.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86618", "type": "CPT"}], "standard_charges": [{"minimum": 15.33, "maximum": 584.01, "discounted_cash": 22.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 11.58, "maximum": 584.01, "discounted_cash": 16.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.69, "methodology": 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"discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 265.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 265.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 265.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 265.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75807", "type": "CPT"}], "standard_charges": [{"minimum": 485.19, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 485.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 485.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 524.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 485.19, "methodology": "fee 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"standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86805", "type": "CPT"}], "standard_charges": [{"minimum": 96.31, "maximum": 584.01, "discounted_cash": 246.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 96.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 96.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 96.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 96.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 170.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 170.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86806", "type": "CPT"}], "standard_charges": [{"minimum": 42.83, "maximum": 584.01, "discounted_cash": 61.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 87.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 87.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 87.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 87.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 42.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 42.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "821", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9963.2, "maximum": 30123.33, "discounted_cash": 20016.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19881.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19881.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30123.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26392.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17389.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14843.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9963.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "820", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25984.92, "maximum": 61901.21, "discounted_cash": 52439.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40855.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40855.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 61901.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 54233.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 35733.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 30503.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 25984.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "822", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5104.33, "maximum": 22008.86, "discounted_cash": 10765.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14526.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14526.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22008.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19282.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12704.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10845.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5104.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "841", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6997.98, "maximum": 17608.19, "discounted_cash": 14586.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11621.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11621.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17608.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15427.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10164.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8676.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6997.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14232.51, "maximum": 30460.57, "discounted_cash": 28924.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20104.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20104.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30460.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26687.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17583.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15010.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14232.51, "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": 9815.92, "maximum": 23740.5, "discounted_cash": 20257.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15668.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15668.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23740.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20799.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13704.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11698.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9815.92, "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": 20884.61, "maximum": 76782.55, "discounted_cash": 40994.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50677.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50677.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 76782.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67271.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44323.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 37836.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 20884.61, "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": 5493.06, "maximum": 14889.6, "discounted_cash": 12065.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9827.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9827.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14889.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13045.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8595.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7337.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5493.06, "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": 4694.63, "maximum": 13120.8, "discounted_cash": 9034.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8659.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8659.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13120.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11495.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7574.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6465.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4694.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 135.94, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 123.38, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 123.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA", "code_information": [{"code": "30560", "type": "CPT"}], "standard_charges": [{"minimum": 415.94, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 415.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL LESION(S)", "code_information": [{"code": "56441", "type": "CPT"}], "standard_charges": [{"minimum": 241.59, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS PENIL CIRCUMIC LESION", "code_information": [{"code": "54162", "type": "CPT"}], "standard_charges": [{"minimum": 352.99, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Laboratory Nonroutine Dialysis", "code_information": [{"code": "304", "type": "RC"}], "standard_charges": [{"minimum": 8.72, "maximum": 11.11, "setting": "outpatient", "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 - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA DIR PROBE", "code_information": [{"code": "87555", "type": "CPT"}], "standard_charges": [{"minimum": 24.19, "maximum": 584.01, "discounted_cash": 34.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA QUANT", "code_information": [{"code": "87557", "type": "CPT"}], "standard_charges": [{"minimum": 38.56, "maximum": 584.01, "discounted_cash": 55.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88373", "type": "CPT"}], "standard_charges": [{"minimum": 42.55, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 179.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 179.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 194.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 179.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 179.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 423.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS SKELETAL MUSC", "code_information": [{"code": "88355", "type": "CPT"}], "standard_charges": [{"minimum": 80.64, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYSISHQUANT/SEMIQ", "code_information": [{"code": "88369", "type": "CPT"}], "standard_charges": [{"minimum": 58.77, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 63.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 74.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 74.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAC PGMT OPT DNS MEAS HFP", "code_information": [{"code": "506T", "type": "CPT"}], "standard_charges": [{"minimum": 111.8, "maximum": 120.74, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM PARASITE", "code_information": [{"code": "87169", "type": "CPT"}], "standard_charges": [{"minimum": 3.88, "maximum": 584.01, "discounted_cash": 5.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.57, "methodology": 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60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 314.26, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 382.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 382.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 413.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 382.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 382.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 314.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE JAW JOINT", "code_information": [{"code": "70336", "type": "CPT"}], "standard_charges": [{"minimum": 251.82, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 305.99, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 24655.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 20493.65, "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": 7368.41, "maximum": 18586.88, "discounted_cash": 15047.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12267.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12267.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18586.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16284.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10729.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9159.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7368.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6690.48, "maximum": 21178.83, "discounted_cash": 12063.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13978.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13978.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21178.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18555.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12225.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10436.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6690.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1561.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1651.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1585.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1645.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1752.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1651.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALE SLING PROCEDURE", "code_information": [{"code": "53440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16495.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5032.93, "maximum": 12862.02, "discounted_cash": 10113.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8489.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8489.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12862.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11268.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7424.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6338.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5032.93, "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": 8143.19, "maximum": 17609.56, "discounted_cash": 16422.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11622.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11622.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17609.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15428.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10165.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8677.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8143.19, "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": 3504.35, "maximum": 10878.48, "discounted_cash": 7629.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7179.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7179.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10878.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9531.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6279.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5360.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3504.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "755", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4954.38, "maximum": 12516.51, "discounted_cash": 9726.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8260.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8260.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12516.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10966.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7225.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6167.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4954.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8074.91, "maximum": 24403.97, "discounted_cash": 16467.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16106.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16106.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24403.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21381.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14087.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12025.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8074.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "756", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4262.16, "maximum": 9200.53, "discounted_cash": 8588.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6072.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6072.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9200.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8060.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5311.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4533.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4262.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "723", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5011.5, "maximum": 19897.31, "discounted_cash": 10217.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13132.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13132.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19897.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17432.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11485.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9804.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5011.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "722", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7716.08, "maximum": 24070.86, "discounted_cash": 16181.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15886.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15886.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24070.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21089.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13895.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11861.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7716.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "724", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3251.74, "maximum": 14365.15, "discounted_cash": 5862.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9481.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9481.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14365.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12585.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8292.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7078.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3251.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [{"code": "598", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4664.67, "maximum": 9466.19, "discounted_cash": 10115.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6247.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6247.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9466.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8293.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5464.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4664.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4815.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [{"code": "597", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7342.6, "maximum": 14900.61, "discounted_cash": 14906.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9834.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9834.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14900.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13054.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8601.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7342.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7840.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "599", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3815.42, "maximum": 7919.0, "discounted_cash": 6879.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5226.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5226.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7919.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6938.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4571.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3902.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3815.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULAT PALM CORD POST INJ", "code_information": [{"code": "26341", "type": "CPT"}], "standard_charges": [{"minimum": 164.16, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATE FINGER W/ANESTH", "code_information": [{"code": "26340", "type": "CPT"}], "standard_charges": [{"minimum": 482.41, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 482.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATE WRIST W/ANESTHES", "code_information": [{"code": "25259", "type": "CPT"}], "standard_charges": [{"minimum": 575.95, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 575.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF HIP JOINT", "code_information": [{"code": "27275", "type": "CPT"}], "standard_charges": [{"minimum": 235.9, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 235.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF KNEE UNDER GENERAL ANESTHESIA 27570", "code_information": [{"code": "27570", "type": "CPT"}, {"code": "1481282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 197.61, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 197.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE REQUIRING ANESTHESIA; ANY REGION 22505", "code_information": [{"code": "22505", "type": "CPT"}, {"code": "42932224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 195.39, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATOR UTERINE 7CMINSTR", "code_information": [{"code": "UM201", "type": "CDM"}], "standard_charges": [{"gross_charge": 18.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MANIPULATOR UTERINE 9CM CLEARVIEW LONG", "code_information": [{"code": "UM202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.04, "setting": "both", "billing_class": "facility"}]}, {"description": "MANUAL CELL COUNT EACH", "code_information": [{"code": "85032", "type": "CPT"}], "standard_charges": [{"minimum": 3.88, "maximum": 584.01, "discounted_cash": 5.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 4.56, "maximum": 584.01, "discounted_cash": 6.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 3.88, "maximum": 584.01, "discounted_cash": 5.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 38.04, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 185.36, "maximum": 3292.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 185.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 185.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 185.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARCAINE 0.75% SPINAL 2ML", "code_information": [{"code": "MED0139", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.11, "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": 9.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN GENTIAN VIOLETINK SURG REG TIP W/ 6IN RULER AND 6 BLANK LABEL LF STR", "code_information": [{"code": "DYNJSM02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.2, "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": 2.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SURG GENTIAN VIOLET SKIN STANDARD TIP W/ FLEXIBLE RULER DEVON LF STRL", "code_information": [{"code": "31145777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SURGI-MARK W 9 LABELS", "code_information": [{"code": "31145884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.47, "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": 7.23, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AEROSOL VINYL ELONGATED ADULT", "code_information": [{"code": "HCS4630B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.89, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AF541EE LEAK 1 4 PT HEADGEAR SMALL", "code_information": [{"code": "73-1120910", "type": "CDM"}], "standard_charges": [{"gross_charge": 226.48, "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": 10.19, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BASIC PROCEDURE FACE WITH EAR LOOPS NON27378", "code_information": [{"code": "NON27378", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK EZPAP W/MOUTHPIECE & MANOMETER 23-23-0757", "code_information": [{"code": "23-23-0757", "type": "CDM"}], "standard_charges": [{"gross_charge": 89.61, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE AF541 4PT HEADGEAR LARGE", "code_information": [{"code": "1120912", "type": "CDM"}], "standard_charges": [{"gross_charge": 214.59, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE AF541 4PT HEADGEAR MEDIUM", "code_information": [{"code": "1120911", "type": "CDM"}], "standard_charges": [{"gross_charge": 102.27, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE CHAMBER FLUID RESIST TIES", "code_information": [{"code": "NON27382FR", "type": "CDM"}], "standard_charges": [{"gross_charge": 1.18, "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": 6.79, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE LG CPAP W/ HEAD GEAR PERFORMATRAK LF DISP", "code_information": [{"code": "1012572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.24, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE PEDIATRIC", "code_information": [{"code": "AT771141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.44, "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": 2.61, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 LARYNGEAL MASK AIRWAY AURA I", "code_information": [{"code": "329300000U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30.47, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 4 LARYNGEAL MASK AIRWAY AURA I", "code_information": [{"code": "329400000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.47, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 5 LARYNGEAL MASK AIRWAY AURA I", "code_information": [{"code": "329500000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.47, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 3 6MM STANDARD ANESTHESIA CUFFED PEDI DISP", "code_information": [{"code": "M0313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 4 6MM STANDARD ANESTHESIA CUFFED ADLT DISP", "code_information": [{"code": "M0323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 5 AIRWAY STANDARD ANESTHESIA ADLT DISP", "code_information": [{"code": "M0333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NASAL W STRAP CONTOUR MED-LRG 1016692", "code_information": [{"code": "1016692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NIV FULL FACE NONVT AAV LRG HCSFFNVAL", "code_information": [{"code": "HCSFFNVAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.02, "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": 2.7, "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": 0.06, "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": 2.77, "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": 9.44, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE INSTA GARD BLUE W/WRA AT7511-WE", "code_information": [{"code": "AT7511-WE", "type": "CDM"}], "standard_charges": [{"gross_charge": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASS SPECTROMETRY QUAL/QUAN", "code_information": [{"code": "83789", "type": "CPT"}], "standard_charges": [{"minimum": 21.7, "maximum": 584.01, "discounted_cash": 31.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 40.32, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST MOD RAD", "code_information": [{"code": "19307", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1472.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1535.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1433.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST SIMPLE COMPLETE", "code_information": [{"code": "19303", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1197.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7815.61, "maximum": 15985.29, "discounted_cash": 17226.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10550.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10550.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15985.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14005.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9227.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7877.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7815.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7331.37, "maximum": 15218.58, "discounted_cash": 15418.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10044.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10044.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15218.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13333.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8785.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7499.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7331.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1209.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69602", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1290.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1565.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1317.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 849.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1122.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOTOMY EXPL DRG ABSC DP", "code_information": [{"code": "19020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRION 1 SQ CM", "code_information": [{"code": "Q4201", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRIX GRAFT 1IN X 1IN ADVANCEIN CRANIAL AND SPINAL DURAPLASTY DURAGEN", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "ID1105", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "gross_charge": 1513.0, "discounted_cash": 155.6, "setting": "both", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRIX HEMOSTATIC 8 ML SURGIFLOW STRL", "code_information": [{"code": "2991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 435.86, "setting": "both", "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL FIXATION", "code_information": [{"code": "21100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAZOR X SPINE DISPOSABLE KIT KIT0574", "code_information": [{"code": "KIT0574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAZOR X SXAN PLAN CE KIT0571", "code_information": [{"code": "KIT0571", "type": "CDM"}], "standard_charges": [{"gross_charge": 2020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ADHESIVE SKIN DERMABOND ADVANCED 0.7 DNX12", "code_information": [{"code": "DNX12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ADHESIVE SKIN TOPICAL EXCED LIQUBAND LX6", "code_information": [{"code": "LX6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-CUFF TOURNIQUET STERILE W/PLC 24\" 60707010400", "code_information": [{"code": "60707010400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.64, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-CUTTER ETS FLEX ARTICNG LINEAR 45MM ATS45", "code_information": [{"code": "ATS45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 756.01, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-DSPNG PIN MULTI ACCESS MINISPIKE", "code_information": [{"code": "412012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.97, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-ELECTRODE ADULT POLYHESIVE PAT RETRN E7507", "code_information": [{"code": "E7507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.46, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GLOVE BIOGEL PL ULTRATOUCH G SZ 7.5", "code_information": [{"code": "42175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.59, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-GOWN XXLG POLY-REINF", "code_information": [{"code": "9070", "type": "CDM"}], "standard_charges": [{"gross_charge": 17.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-INFUSION SET VENTED NON-VENTED 2-PC", "code_information": [{"code": "2204-0007", "type": "CDM"}], "standard_charges": [{"gross_charge": 13.78, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-LIQUID ADHESIVE 2/3CC 0496-0523-48", "code_information": [{"code": "496-0523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-NEEDLE 22GX3\" YELLW HUB STRL SNG USE 405171", "code_information": [{"code": "405171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-PAD CLEANER CAUTERY", "code_information": [{"code": "300-2SS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.89, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-RELOAD ENDO STITCH SURGDAC GRN 0 48 173024", "code_information": [{"code": "173024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-RELOAD ENDOSTITCH SURGDAC GRN 2-0 48 173023", "code_information": [{"code": "173023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET BLOOD WARMING AND FLUID ADMIN D-100", "code_information": [{"code": "D-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2546.78, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET INFSOMT LUER 15 DP/ML 120IN 22ML 490100", "code_information": [{"code": "490100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET PMP 15 DROP UNIV SPIKE 2 CRESITE", "code_information": [{"code": "490102", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.52, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SET SUCTION INTERLINK BLD SOLTN TYP 2C6750H", "code_information": [{"code": "2C6750H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SOD CHLOR  0.9% IRG 1000ML 2F7124", "code_information": [{"code": "2F7124", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SOD CHLORIDE INJ  0.9% 2B1309", "code_information": [{"code": "2B1309", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.18, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTION SODIUM CHLOR INJ 0.9% 50ML  2B1301", "code_information": [{"code": "2B1301", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.69, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SOLUTN SODIUM CHLOR INJ 0.9% 100 ML 2B1307", "code_information": [{"code": "2B1307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.52, "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": 34.77, "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": 33.66, "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": 38.62, "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": 87.85, "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": 24.83, "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": 569.65, "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": 236.68, "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": 51.52, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 3-0 BLACK BRAIDED 12-18 A184H", "code_information": [{"code": "A184H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.99, "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": 14.54, "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": 62.54, "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": 236.68, "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": 11.02, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE PRMA-HAND 3/0 12-30 BLK BRAID A304H", "code_information": [{"code": "A304H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE VLOC 180 ESTITCH ABS 8 LOOP VLOCA008L", "code_information": [{"code": "VLOCA008L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 397.35, "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": 397.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 321.87, "discounted_cash": 464.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 321.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 321.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCOLN1 GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 35.38, "maximum": 584.01, "discounted_cash": 51.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 651.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 690.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 727.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.38, "maximum": 76.38, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD DOCUMENT VISIT BY NPP", "code_information": [{"code": "G0454", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.43, "maximum": 12.43, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.43, "maximum": 12.43, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.82, "maximum": 12.82, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1919.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 23.1, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE BLOOD OXYGEN LEVEL", "code_information": [{"code": "94761", "type": "CPT"}], "standard_charges": [{"minimum": 5.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 136.7, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "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": 16.28, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 73.76, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 16.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 768.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 155.33, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"minimum": 33.35, "maximum": 584.01, "discounted_cash": 273.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 19.7, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 340.15, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 340.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 475.08, "discounted_cash": 686.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 135.0, "maximum": 584.01, "discounted_cash": 195.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 584.01, "discounted_cash": 686.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 108.0, "maximum": 584.01, "discounted_cash": 156.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 43.39, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1354.21, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1011.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1011.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1093.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1011.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1011.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1354.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERV 10PM-8AM 24 HR FAC", "code_information": [{"code": "99053", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERV EVE/WKEND/HOLIDAY", "code_information": [{"code": "99051", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERVICE OUT OF OFFICE", "code_information": [{"code": "99056", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDI-VAC SUCTION TUBING BXTN612", "code_information": [{"code": "BXTN612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDI-VAC YANKAUER STERILE SUCTION HANDLES BXTK86", "code_information": [{"code": "BXTK86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.01, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"minimum": 494.62, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 494.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"minimum": 383.1, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 383.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7615.66, "maximum": 21352.27, "discounted_cash": 14986.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14092.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14092.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21352.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18707.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12325.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10521.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7615.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4301.44, "maximum": 13502.09, "discounted_cash": 8595.33, "estimated_discounted_cash": 2956.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8911.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8911.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13502.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11829.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7794.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6653.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4301.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION GROUP", "code_information": [{"code": "97804", "type": "CPT"}], "standard_charges": [{"minimum": 23.25, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION INDIV IN", "code_information": [{"code": "97802", "type": "CPT"}], "standard_charges": [{"minimum": 50.3, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL SERVICES AFTER HRS", "code_information": [{"code": "99050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL TESTIMONY", "code_information": [{"code": "99075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICATED PETROLATUM GAUZE DRESSING, 5X9", "code_information": [{"code": "C-WMD59", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.04, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDICINE UP 2oz STERILE 12493-500", "code_information": [{"code": "12493-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDISKIN", "code_information": [{"code": "Q4135", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDLINE SAFETY LANCETS ST28", "code_information": [{"code": "ST28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MEG EVOKED EACH ADDL", "code_information": [{"code": "95967", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1469.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1360.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1360.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1469.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1360.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED SINGLE", "code_information": [{"code": "95966", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3710.45, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3435.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3435.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3710.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3435.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEG SPONTANEOUS", "code_information": [{"code": "95965", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6146.09, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5690.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5690.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6146.09, "methodology": "fee 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PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [{"code": "Q4126", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT MENB-FHBP VACC IM", "code_information": [{"code": "90623", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT VACCINE IM", "code_information": [{"code": "90619", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENACWYD/MENACWYCRM VACC IM", "code_information": [{"code": "90734", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-4C VACC 2 DOSE IM", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4398.73, "maximum": 9770.4, "discounted_cash": 9008.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6448.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6448.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9770.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8560.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5640.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4814.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4398.73, "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": 2829.1, "maximum": 8283.78, "discounted_cash": 5101.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5467.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5467.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8283.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7257.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4781.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4082.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2829.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEPILEX BORDER FLEX FOAM DRESSING 4X4 595300", "code_information": [{"code": "595300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER SACRUM DRESSING WITH SAFETAC 8.7\"X9.8\" 282455", "code_information": [{"code": "282455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 1%/CARBOCAINE 30ML", "code_information": [{"code": "MED0137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.8, "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": 27.04, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH COMPOSITE 12CM ROUND OPTIMIZED PARIETEX", "code_information": [{"code": "PCO12X", "type": "CDM"}], "standard_charges": [{"gross_charge": 1896.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ROUND 12MM X 6MM", "code_information": [{"code": "1760-12-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6048.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH SURG 15CM X 10CM OPTIMIZED COMPOSITE PARIETEX", "code_information": [{"code": "PCO1510X", "type": "CDM"}], "standard_charges": [{"gross_charge": 1821.04, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 10 MG/1 ML", "code_information": [{"code": "MED0140", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 92.9, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 100 MG/10 ML", "code_information": [{"code": "MED0141", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENEDIOXYAMPHETAMINES", "code_information": [{"code": "80359", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPHENIDATE", "code_information": [{"code": "80360", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "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": 23.71, "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": 14.27, "setting": "both", "billing_class": "facility"}]}, {"description": "METYRAPONE PANEL", "code_information": [{"code": "80436", "type": "CPT"}], "standard_charges": [{"minimum": 82.04, "maximum": 584.01, "discounted_cash": 118.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 167.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 167.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 181.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 167.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 167.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MGMT GENE PRMTR MTHYLTN ALYS", "code_information": [{"code": "81287", "type": "CPT"}], "standard_charges": [{"minimum": 112.17, "maximum": 584.01, "discounted_cash": 162.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 121.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 112.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 112.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 112.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MACROBROTH", "code_information": [{"code": "87188", "type": "CPT"}], "standard_charges": [{"minimum": 5.98, "maximum": 584.01, "discounted_cash": 8.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE 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5.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MYCOBACTERI", "code_information": [{"code": "87190", "type": "CPT"}], "standard_charges": [{"minimum": 1.38, "maximum": 584.01, "discounted_cash": 9.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DIFFUSE", "code_information": [{"code": "87181", "type": "CPT"}], "standard_charges": [{"minimum": 4.28, "maximum": 584.01, "discounted_cash": 6.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DISK", "code_information": [{"code": "87184", "type": "CPT"}], "standard_charges": [{"minimum": 6.73, "maximum": 584.01, "discounted_cash": 9.72, 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[{"code": "88380", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 127.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 127.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 141.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 141.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", "type": "CPT"}], "standard_charges": 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"plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROLINE RE-NEW II ENDOCUT SCISSOR TIP 16.51MM : 5.0MM", "code_information": [{"code": "3142R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.23, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROLYTE MATRIX, PER SQ CM", "code_information": [{"code": "A2005", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROPITUITARY 9569565 2MM 9569565", "code_information": [{"code": "9569565", "type": "CDM"}], "standard_charges": [{"gross_charge": 2608.22, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROPORE SURGICAL TAPE MMM15301Z", "code_information": [{"code": "MMM15301Z", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.86, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROSATELLITE INSTABILITY", "code_information": [{"code": "81301", "type": "CPT"}], "standard_charges": [{"minimum": 313.7, "maximum": 584.01, "discounted_cash": 453.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 533.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 533.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 576.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 533.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 533.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSOMAL ANTIBODY EACH", "code_information": [{"code": "86376", "type": "CPT"}], "standard_charges": [{"minimum": 13.1, "maximum": 584.01, "discounted_cash": 18.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROVOLT T-WAVE ASSESS", "code_information": [{"code": "93025", "type": "CPT"}], "standard_charges": [{"minimum": 128.8, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR 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{"description": "MLH1 GENE FULL SEQ", "code_information": [{"code": "81292", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 943.51, "discounted_cash": 878.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 872.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 872.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 872.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 872.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 607.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 607.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE KNOWN VARIANTS", "code_information": [{"code": "81293", "type": "CPT"}], "standard_charges": [{"minimum": 297.9, "maximum": 584.01, "discounted_cash": 430.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 349.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 349.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 378.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 349.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 349.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLH1 MRNA SEQ ALYS", "code_information": [{"code": "158U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 254.59, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN 1ST 60", "code_information": [{"code": "96202", "type": "CPT"}], "standard_charges": [{"minimum": 27.97, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN EA ADD", "code_information": [{"code": "96203", "type": "CPT"}], "standard_charges": [{"minimum": 7.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MMR VACCINE SC", "code_information": [{"code": "90707", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MMRV VACCINE SC", "code_information": [{"code": "90710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ DP RX DLVR DEV", "code_information": [{"code": "20700", "type": "CPT"}], "standard_charges": [{"minimum": 112.95, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"minimum": 206.02, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"minimum": 195.87, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNPJ ANES SHO JT FIXJ APRATS", "code_information": [{"code": "23700", "type": "CPT"}], "standard_charges": [{"minimum": 244.33, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNPJ ELBOW UNDER ANES", "code_information": [{"code": "24300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 569.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.39, "maximum": 62.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"minimum": 140.83, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP 5/>YRS", "code_information": [{"code": "99156", "type": "CPT"}], "standard_charges": [{"minimum": 97.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP <5 YRS", "code_information": [{"code": "99155", "type": "CPT"}], "standard_charges": [{"minimum": 110.85, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTHER PHYS/QHP EA", "code_information": [{"code": "99157", "type": "CPT"}], "standard_charges": [{"minimum": 73.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP 5/>YRS", "code_information": [{"code": "99152", "type": "CPT"}], "standard_charges": [{"minimum": 67.98, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP <5 YRS", "code_information": [{"code": "99151", "type": "CPT"}], "standard_charges": [{"minimum": 83.09, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 83.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP EA", "code_information": [{"code": "99153", "type": "CPT"}], "standard_charges": [{"minimum": 16.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SEDAT ENDO SERVICE >5YRS", "code_information": [{"code": "G0500", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.46, "maximum": 87.46, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODIFICATION OF CONTACT LENS", "code_information": [{"code": "92325", "type": "CPT"}], "standard_charges": [{"minimum": 61.11, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 80.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODULE PLT FOR 2.4 MM LCP VOLAR COLUM DIST RADIUS PLATE W/ 6 HOLE OR 7 HOLE HEAD", "code_information": [{"code": "60.110.049", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.93, "setting": "both", "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB CBA EACH", "code_information": [{"code": "86362", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, "discounted_cash": 49.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 535.76, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 512.66, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 106.23, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATHOLOGY INTERPR", "code_information": [{"code": "G0452", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.63, "maximum": 3.76, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONITORING KIT PRESS W/TRANS 84\" (5 42585-05", "code_information": [{"code": "42585-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MONONUCLEAR CELL ANTIGEN", "code_information": [{"code": "86356", "type": "CPT"}], "standard_charges": [{"minimum": 24.1, "maximum": 584.01, "discounted_cash": 34.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONSEL'S SOLUTION 30ML SOLUTION", "code_information": [{"code": "MED0148", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.28, "setting": "both", "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}], "standard_charges": [{"minimum": 57.56, "maximum": 584.01, "discounted_cash": 83.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 57.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 57.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 2", "code_information": [{"code": "81401", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 204.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 3", "code_information": [{"code": "81402", "type": "CPT"}], "standard_charges": [{"minimum": 135.3, "maximum": 584.01, "discounted_cash": 195.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 276.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 276.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 299.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 276.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 276.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 135.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 135.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 4", "code_information": [{"code": "81403", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 584.01, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 343.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 584.01, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 657.0, "discounted_cash": 391.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 657.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}], "standard_charges": [{"minimum": 254.59, "maximum": 949.0, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 949.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1387.0, "discounted_cash": 1100.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1387.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 2227.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2409.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2227.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2227.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE PF/DURAMORPH 10MG/10ML", "code_information": [{"code": "MED0149", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 42.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE/DURAMORPH 5MG/10ML", "code_information": [{"code": "MED0150", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MOST, per square centimeter", "code_information": [{"code": "Q4328", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTION ANALYSIS VIDEO/3D", "code_information": [{"code": "96000", "type": "CPT"}], "standard_charges": [{"minimum": 99.2, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 182.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 182.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 182.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTION FLUOROSCOPY/SWALLOW", "code_information": [{"code": "92611", "type": "CPT"}], "standard_charges": [{"minimum": 124.81, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 173.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 173.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 186.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 173.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": 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MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3243.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTHFR GENE", "code_information": [{"code": "81291", "type": "CPT"}], "standard_charges": [{"minimum": 58.81, "maximum": 584.01, "discounted_cash": 84.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM ADDL 15 MIN", "code_information": [{"code": "99607", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM EST 15 MIN", "code_information": [{"code": "99606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM NP 15 MIN", "code_information": [{"code": "99605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCOPOLYSACCHARIDES", "code_information": [{"code": "83864", "type": "CPT"}], "standard_charges": [{"minimum": 25.65, "maximum": 584.01, "discounted_cash": 37.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCORMYCOSIS ANTIBODY", "code_information": [{"code": "86732", "type": "CPT"}], "standard_charges": [{"minimum": 13.5, "maximum": 584.01, "discounted_cash": 19.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULT FAM ADAPT BHV TX GDN", "code_information": [{"code": "97157", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIFOCAL ERG W/I&R", "code_information": [{"code": "92274", "type": "CPT"}], "standard_charges": [{"minimum": 78.19, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 113.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 78.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIHANCE 5 ML GADOBENATE DIMEGLUMINE 529 MG/ML IV SOL 5 ML", "code_information": [{"code": "MED0242", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MULTIPLE FAMILY GROUP PSYTX", "code_information": [{"code": "90849", "type": "CPT"}], "standard_charges": [{"minimum": 55.56, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 55.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC", "code_information": [{"code": "427", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31699.35, "maximum": 97768.67, "discounted_cash": 64544.1, "estimated_discounted_cash": 109662.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64528.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64528.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 97768.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 85658.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 56438.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 48177.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 31699.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "426", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46751.71, "maximum": 144193.88, "discounted_cash": 98544.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95169.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95169.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 144193.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 126333.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 83237.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 71054.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 46751.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC", "code_information": [{"code": "428", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24564.8, "maximum": 75763.94, "discounted_cash": 50268.34, "estimated_discounted_cash": 80535.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50004.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50004.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75763.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66379.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 43735.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 37334.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24564.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "447", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29923.08, "maximum": 92290.2, "discounted_cash": 59742.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60912.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60912.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 92290.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80858.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 53275.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 45477.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 29923.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "448", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18224.66, "maximum": 56209.38, "discounted_cash": 37918.53, "estimated_discounted_cash": 82756.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37098.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37098.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56209.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49247.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32447.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 27698.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18224.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "59", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5287.35, "maximum": 10729.82, "discounted_cash": 11095.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7081.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7081.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10729.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9400.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6193.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5287.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5460.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "58", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7294.44, "maximum": 14802.88, "discounted_cash": 15285.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9770.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9770.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14802.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12969.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8545.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7294.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8238.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC", "code_information": [{"code": "60", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3982.78, "maximum": 8729.76, "discounted_cash": 8224.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5761.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5761.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8729.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7648.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5039.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4301.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3982.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SLEEP LATENCY TEST", "code_information": [{"code": "95805", "type": "CPT"}], "standard_charges": [{"minimum": 551.25, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 650.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 650.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 702.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 650.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPOINT SCREW 2.4X10MM 102026210S", "code_information": [{"code": "102026210S", "type": "CDM"}], "standard_charges": [{"gross_charge": 520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MUPIROCIN 2% 22GM OINTMENT/ BACTROBAN", "code_information": [{"code": "MED0152", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MUPIROCIN NASAL 2% 1 GRAM OINTMENT/BACTROBAN", "code_information": [{"code": "MED0153", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}], "standard_charges": [{"minimum": 16.88, "maximum": 584.01, "discounted_cash": 24.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURILUBE 2ML", "code_information": [{"code": "MED0151", "type": "CDM"}], "standard_charges": [{"gross_charge": 133.44, "setting": "both", "billing_class": "facility"}]}, {"description": "MUSC MYOQ/FSCQ FLP H&N PEDCL", "code_information": [{"code": "15733", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1211.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC TEST DONE W/N TEST COMP", "code_information": [{"code": "95886", "type": "CPT"}], "standard_charges": [{"minimum": 71.8, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/N TST NONEXT", "code_information": [{"code": "95887", "type": "CPT"}], "standard_charges": [{"minimum": 66.98, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 93.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 66.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/NERV TST LIM", "code_information": [{"code": "95885", "type": "CPT"}], "standard_charges": [{"minimum": 60.42, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 76.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC/TDN TRANSFER UPR A/E 1", "code_information": [{"code": "24301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 925.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 2 LIMBS", "code_information": [{"code": "95861", "type": "CPT"}], "standard_charges": [{"minimum": 106.2, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 181.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 106.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 3 LIMBS", "code_information": [{"code": "95863", "type": "CPT"}], "standard_charges": [{"minimum": 159.18, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 225.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 225.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 243.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 225.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 178.01, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 178.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERV UNILAT", "code_information": [{"code": "95867", "type": "CPT"}], "standard_charges": [{"minimum": 86.94, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 117.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERVE BILAT", "code_information": [{"code": "95868", "type": "CPT"}], "standard_charges": [{"minimum": 88.26, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 132.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 132.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 143.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 132.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 91.75, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 123.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 123.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 133.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 123.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST LARYNX", "code_information": [{"code": "95865", "type": "CPT"}], "standard_charges": [{"minimum": 92.2, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 115.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 115.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 125.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 115.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST NONPARASPINAL", "code_information": [{"code": "95870", "type": "CPT"}], "standard_charges": [{"minimum": 87.39, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 148.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 77.58, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE LIMB", "code_information": [{"code": "95860", "type": "CPT"}], "standard_charges": [{"minimum": 89.13, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 141.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 130.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST THOR PARASPINAL", "code_information": [{"code": "95869", "type": "CPT"}], "standard_charges": [{"minimum": 98.76, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 146.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 98.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER SHOULDER/ARM", "code_information": [{"code": "23395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1556.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFERS", "code_information": [{"code": "23397", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1376.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-MYOCUTANEOUS-OR FASCIOCUTANEOUS FLAP-TRUNK 15734", "code_information": [{"code": "15734", "type": "CPT"}, {"code": "1482288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3437.0, "discounted_cash": 4430.73, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1826.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT ARM", "code_information": [{"code": "15736", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1469.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT LEG", "code_information": [{"code": "15738", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1521.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 584.01, "discounted_cash": 23.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA AMP PROBE", "code_information": [{"code": "87551", "type": "CPT"}], "standard_charges": [{"minimum": 43.42, "maximum": 584.01, "discounted_cash": 62.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 43.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 43.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA DIR PROBE", "code_information": [{"code": "87550", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA QUANT", "code_information": [{"code": "87552", "type": "CPT"}], "standard_charges": [{"minimum": 38.56, "maximum": 584.01, "discounted_cash": 55.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIC IDENTIFICATION", "code_information": [{"code": "87118", "type": "CPT"}], "standard_charges": [{"minimum": 13.15, "maximum": 584.01, "discounted_cash": 18.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA", "code_information": [{"code": "87109", "type": "CPT"}], "standard_charges": [{"minimum": 13.85, "maximum": 584.01, "discounted_cash": 20.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA ANTIBODY", "code_information": [{"code": "86738", "type": "CPT"}], "standard_charges": [{"minimum": 11.92, "maximum": 584.01, "discounted_cash": 17.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYD88 GENE P.LEU265PRO VRNT", "code_information": [{"code": "81305", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 584.01, "discounted_cash": 228.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 256.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGPHY 2/> SPINE REGIONS", "code_information": [{"code": "72270", "type": "CPT"}], "standard_charges": [{"minimum": 96.14, "maximum": 584.01, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY L-S SPINE", "code_information": [{"code": "72265", "type": "CPT"}], "standard_charges": [{"minimum": 91.75, "maximum": 584.01, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 104.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 326.74, "maximum": 4936.0, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 326.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 332.18, "maximum": 4936.0, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62304", "type": "CPT"}], "standard_charges": [{"minimum": 323.95, "maximum": 4936.0, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 323.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 352.84, "maximum": 4936.0, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY NECK SPINE", "code_information": [{"code": "72240", "type": "CPT"}], "standard_charges": [{"minimum": 90.01, "maximum": 584.01, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 103.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 103.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 103.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 103.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY THORACIC SPINE", "code_information": [{"code": "72255", "type": "CPT"}], "standard_charges": [{"minimum": 81.26, "maximum": 584.01, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 103.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 95.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 95.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.26, "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": 10532.23, "maximum": 34848.85, "discounted_cash": 20665.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23000.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23000.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34848.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30532.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20116.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17172.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10532.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. 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BLUE NETWORK E", "standard_charge_dollar": 129.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 129.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 141.39, "maximum": 584.01, "discounted_cash": 2754.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 74.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 80.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-INVAS EST C FFR SW ALY CTA", "code_information": [{"code": "75580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1117.1, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1117.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 21.09, "maximum": 584.01, "discounted_cash": 31.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA AMP PROB", "code_information": [{"code": "87591", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 24.19, "maximum": 584.01, "discounted_cash": 34.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": [{"code": "87592", "type": "CPT"}], "standard_charges": [{"minimum": 38.56, "maximum": 584.01, "discounted_cash": 55.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NACL 0.9% PF FOR INJECTION 50ML VIAL", "code_information": [{"code": "MED0154", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NACL 3000ML BAG", "code_information": [{"code": "MED0269", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NARCOSYNTHESIS", "code_information": [{"code": "90865", "type": "CPT"}], "standard_charges": [{"minimum": 233.83, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 233.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY DX", "code_information": [{"code": "31231", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 87.02, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SALINE 0.65% SPRAY 45 ML", "code_information": [{"code": "MED0155", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SINUS THERAPY", "code_information": [{"code": "30210", "type": "CPT"}], "standard_charges": [{"minimum": 206.15, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SMEAR FOR EOSINOPHILS", "code_information": [{"code": "89190", "type": "CPT"}], "standard_charges": [{"minimum": 5.21, "maximum": 584.01, "discounted_cash": 7.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 46.95, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31287", "type": "CPT"}], "standard_charges": [{"minimum": 229.62, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 229.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31288", "type": "CPT"}], "standard_charges": [{"minimum": 266.76, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 266.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1329.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1429.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL AIRWAY 32 FR 123132", "code_information": [{"code": "123132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.64, "setting": "both", "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY", "code_information": [{"code": "92511", "type": "CPT"}], "standard_charges": [{"minimum": 153.79, "maximum": 1100.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 272.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP 60 MIN PR M", "code_information": [{"code": "G0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.02, "maximum": 120.02, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 120.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP ADD 30 PR M", "code_information": [{"code": "G0146", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.4, "maximum": 72.4, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 72.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1520.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 171.61, "maximum": 584.01, "discounted_cash": 826.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 171.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG 1ST", "code_information": [{"code": "598T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 33.58, "maximum": 4936.0, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"minimum": 51.44, "maximum": 4936.0, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 56.3, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.3, "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": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 206.85, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 206.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"minimum": 111.8, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEBULIZER MEDICATION MED UPMIST", "code_information": [{"code": "2438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.27, "setting": "both", "billing_class": "facility"}]}, {"description": "NEBULIZER MISTY O2 TBG T ADAPT MOUTH 002446", "code_information": [{"code": "2446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.49, "setting": "both", "billing_class": "facility"}]}, {"description": "NEBULIZER PT 6CC 90DEG SM VOLUME EASY SEAL THREADED CAP HND HELD ORIN LINE W/ 7F", "code_information": [{"code": "1883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.42, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11G JAMSHIDI  DJ6011X", "code_information": [{"code": "DJ6011X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18GX6 PINK HUB STRL SINGLE USE 408360", "code_information": [{"code": "408360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.73, "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": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX5 BLACK LONG STRL SINGLE USE 405148", "code_information": [{"code": "405148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.7, "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": 22.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX3.5 SPINAL STERILE PENCAN", "code_information": [{"code": "333853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.71, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX5\"SPINALSTRL PENCAN 25/CS 333875", "code_information": [{"code": "333875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.81, "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": 95.76, "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": 139.93, "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": 100.54, "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": 11.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 222.34, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER ADD-ON", "code_information": [{"code": "47001", "type": "CPT"}], "standard_charges": [{"minimum": 120.95, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 120.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 227.03, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY OF LIVER", "code_information": [{"code": "47000", "type": "CPT"}], "standard_charges": [{"minimum": 381.41, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 381.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY PANCREAS", "code_information": [{"code": "48102", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 657.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINAL CORD", "code_information": [{"code": "62269", "type": "CPT"}], "standard_charges": [{"minimum": 304.29, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE ELECTRODE 2.84IN .093IN BOVIE TIP", "code_information": [{"code": "E1552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.11, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 14GA CURVED COUDE NEUROMODULATION", "code_information": [{"code": "SC-4210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 14GA X 101.6MM RADIOPAQUE FOR SPINAL CORD STIMULATION PROCEDURE RX CO", "code_information": [{"code": "105-1314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPI 18GA X 3.5IN TUOHY REMOVABLE WING REG WALL PLASTIC HUB STRL DISP", "code_information": [{"code": "183A07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.87, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FERGUSON ROUND BODY 1/2 CIRCLE", "code_information": [{"code": "1842-12DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 257.55, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FISTULA SZ 7 SUT ANCHOR REVERSE CUTTING HALF CIRC DISP", "code_information": [{"code": "1832-7DC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HYPO SAFETY 22 X 1 1/2 8881850215", "code_information": [{"code": "8881850215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HYPODERMIC SAFETY 22G X 1.5 SSN100227Z", "code_information": [{"code": "SSN100227Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INF 19GA X 3/4IN X 6IN 90DEG NDL WINGED HUBER FEMALE LUER CONNECTOR ON AND", "code_information": [{"code": "471696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.22, "setting": "both", "billing_class": 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"CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 627.82, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PAK NEEDLE", "code_information": [{"code": "PK1003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.63, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PAK NEEDLE TROCAR", "code_information": [{"code": "PK1002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.63, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PERIPHERAL NERVE 21GA X 4IN NDL NERVE STIMULATION 30 DEGREE BEVEL ATTACHE", "code_information": [{"code": "4894260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PNEUMOPERITONEUM 14G 120MM 172015", "code_information": [{"code": "172015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.71, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE QUINCKE 22GX5", "code_information": [{"code": "PAIN8123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SAFETY 25G X 1.5 SSN100257Z", "code_information": [{"code": "SSN100257Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.94, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 20GA X3.5 QUINCKE S2035", "code_information": [{"code": "S2035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.54, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GA X 3 1/2   405181", "code_information": [{"code": "405181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 22GAX5 SPINOCAN STERILE 333355", "code_information": [{"code": "333355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.01, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 24GA X 4IN PURPLE PENCIL POINT WITH INTRODUCER PENCAN LATEX FREE STAINLESS STEEL STERI", "code_information": [{"code": "333884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.81, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINE ENTRADA", "code_information": [{"code": "SC-4220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPNL 25GA X 6IN ORANGE PENCIL POINT REG WALL PENCAN SS STRL DISP", "code_information": [{"code": "333877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.81, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURG 150MM", "code_information": [{"code": "172016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SURIGICAL 18GA X 3.5IN TUOHY NDL EPI W/ CLR HUB AND WING PERIFIX", "code_information": [{"code": "332166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.62, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SUT REPROCESS SCORPION SUREFIREINSTR", "code_information": [{"code": "AR13991NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.73, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TAPERES CURVED 26MM 1/2 CIRCLE XLOOP", "code_information": [{"code": "AR-7281", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 921.12, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TRANSFER 18GA X 1 1/2IN MEDICATION TRANSFER BLUNT FILL STRL DISP", "code_information": [{"code": "305180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY EPID 20GX6\" METAL STYLET", "code_information": [{"code": "PAIN8010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.74, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE X PAK W/ 2 TROCAR TIPS FOR RODINSERTION", "code_information": [{"code": "8670015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 627.82, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES SAFETYGLIDE STERILE HYPODERMIC 18G X 1.5\" 305918", "code_information": [{"code": "305918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.26, "setting": "both", "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 77.56, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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"standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER DME>50 SQCM", "code_information": [{"code": "97606", "type": "CPT"}], "standard_charges": [{"minimum": 68.51, "maximum": 584.01, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 90.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER NDME>50SQCM", "code_information": [{"code": "97608", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 671.33, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 671.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 521.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THR NDME<=50SQCM", "code_information": [{"code": "97607", "type": "CPT"}], "standard_charges": [{"minimum": 482.71, "maximum": 671.33, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 671.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 482.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEO/POLY/BACI PACKET 1GM", "code_information": [{"code": "MED0160", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.52, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/DEX (MAXITROL) OPHTHALMIC OINTMENT 3.5GM", "code_information": [{"code": "MED0157", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 68.22, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/HYDROCORT 1% 10ML OTIC SOLUTION/ CORTISPORIN", "code_information": [{"code": "MED0158", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 238.04, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLYMYXIN/BACITRACIN (NEOSPORIN) OINT 15GM", "code_information": [{"code": "MED0159", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMATRIX PER SQ CM", "code_information": [{"code": "A2021", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLY IRR MDV 20 ML 972909", "code_information": [{"code": "972909", "type": "CDM"}], "standard_charges": [{"gross_charge": 344.88, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMIXIN B SULFATE IRRIGATION 1 ML", "code_information": [{"code": "MED0231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMYXIN/DEXAMTHASONE JELLY", "code_information": [{"code": "MED0161", "type": "CDM"}], "standard_charges": [{"gross_charge": 43.86, "setting": "both", "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1081.02, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1081.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE SUBSQ", "code_information": [{"code": "99469", "type": "CPT"}], "standard_charges": [{"minimum": 467.73, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", 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351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"minimum": 855.0, "maximum": 1387.0, "discounted_cash": 1235.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1387.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"minimum": 47.44, "maximum": 47.44, "discounted_cash": 68.52, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD RSK HI STG 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1247.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1496.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1185.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3140.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2098.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1178.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1543.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE REPAIR W/ALLOGRAFT", "code_information": [{"code": "64910", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 280.21, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE TEASING PREPARATIONS", "code_information": [{"code": "88362", "type": "CPT"}], "standard_charges": [{"minimum": 147.88, "maximum": 584.01, "discounted_cash": 1007.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 565.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6690.48, "maximum": 22929.74, "discounted_cash": 13652.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15133.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15133.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22929.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20089.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13236.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11299.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6690.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4869.13, "maximum": 20271.72, "discounted_cash": 9116.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13379.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13379.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20271.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17760.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11702.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9989.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4869.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"minimum": 486.89, "maximum": 486.89, "discounted_cash": 703.29, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"minimum": 178.87, "maximum": 178.87, "discounted_cash": 258.36, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAXL LBR ANES VAG DLVR", "code_information": [{"code": "1967", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT", "code_information": [{"code": "28055", "type": "CPT"}], "standard_charges": [{"minimum": 501.79, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 712.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 664.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALYS B-AMYL 1-42&1-40", "code_information": [{"code": "358U", "type": "CPT"}], "standard_charges": [{"minimum": 234.45, "maximum": 234.45, "discounted_cash": 338.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1993.86, "discounted_cash": 2880.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 684.0, "discounted_cash": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 460.08, "discounted_cash": 664.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"minimum": 675.0, "maximum": 675.0, "discounted_cash": 975.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 675.0, "maximum": 675.0, "discounted_cash": 975.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"minimum": 1579.5, "maximum": 2562.3, "discounted_cash": 2535.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2369.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2369.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2562.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2369.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2369.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 675.0, "discounted_cash": 975.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "410U", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 1044.0, "discounted_cash": 1508.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 486.89, "maximum": 789.85, "discounted_cash": 703.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 730.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 730.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 789.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 730.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 730.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1383.32, "discounted_cash": 1998.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1978.52, "discounted_cash": 2857.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 2051.1, "maximum": 3327.34, "discounted_cash": 2962.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3076.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3076.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3327.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3076.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3076.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 155.0, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 217.08, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 217.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3584.68, "maximum": 7307.84, "discounted_cash": 7140.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4823.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4823.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7307.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6402.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4218.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3601.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3584.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROMONITORING", "code_information": [{"code": "2862-02-208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1838.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR JUNCTION TEST", "code_information": [{"code": "95937", "type": "CPT"}], "standard_charges": [{"minimum": 82.72, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 44.92, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;MEDIAN NERVE AT CARPAL TUNNEL 64721", "code_information": [{"code": "64721", "type": "CPT"}, {"code": "1481356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "estimated_discounted_cash": 5190.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2281.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;ULNAR NERVE AT ELBOW 64718", "code_information": [{"code": "64718", "type": "CPT"}, {"code": "1481357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "estimated_discounted_cash": 18244.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2678.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2281.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 759.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY AND/OR TRANSPOSITION;ULNAR NERVE AT WRIST 64719", "code_information": [{"code": "64719", "type": "CPT"}, {"code": "1481358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2281.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY MAJOR PERIPHERAL NERVE ARM OR LEG OPEN 64708", "code_information": [{"code": "64708", "type": "CPT"}, {"code": "1481360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 620.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1253.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3367.08, "maximum": 6832.95, "discounted_cash": 9601.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4509.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4509.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6832.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5986.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3944.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3367.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4293.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP", "code_information": [{"code": "15750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1113.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRALIZATION TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}], "standard_charges": [{"minimum": 14.58, "maximum": 584.01, "discounted_cash": 21.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 54.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 103.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRON BEAM TX COMPLEX", "code_information": [{"code": "77423", "type": "CPT"}], "standard_charges": [{"minimum": 60.18, "maximum": 584.01, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 60.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN+", "code_information": [{"code": "99316", "type": "CPT"}], "standard_charges": [{"minimum": 189.16, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 189.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN/LESS", "code_information": [{"code": "99315", "type": "CPT"}], "standard_charges": [{"minimum": 117.48, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 115.46, "maximum": 584.01, "discounted_cash": 166.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 254.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 115.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 115.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 231.71, "maximum": 584.01, "discounted_cash": 334.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP B", "code_information": [{"code": "87912", "type": "CPT"}], "standard_charges": [{"minimum": 231.71, "maximum": 584.01, "discounted_cash": 334.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP C", "code_information": [{"code": "87902", "type": "CPT"}], "standard_charges": [{"minimum": 231.71, "maximum": 584.01, "discounted_cash": 334.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1", "code_information": [{"code": "87906", "type": "CPT"}], "standard_charges": [{"minimum": 115.86, "maximum": 584.01, "discounted_cash": 167.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 165.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 165.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 165.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 165.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 115.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 115.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1 REV", "code_information": [{"code": "87901", "type": "CPT"}], "standard_charges": [{"minimum": 231.71, "maximum": 584.01, "discounted_cash": 334.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 331.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 231.71, "maximum": 584.01, "discounted_cash": 334.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 231.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT HIV GNRJ SEQ ALYS", "code_information": [{"code": "219U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 652.5, "discounted_cash": 942.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 128.37, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "736T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 435.96, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 435.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"minimum": 375.09, "maximum": 435.96, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 435.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 403.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 141.08, "discounted_cash": 203.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 141.08, "discounted_cash": 203.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 180.0, "discounted_cash": 260.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 7.27, "maximum": 7.27, "discounted_cash": 10.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 234.45, "maximum": 234.45, "discounted_cash": 338.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 584.01, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 192.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS AMP PRB", "code_information": [{"code": "352U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 128.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 236.69, "maximum": 584.01, "discounted_cash": 341.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 355.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 355.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 383.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 355.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 355.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}], "standard_charges": [{"minimum": 64.97, "maximum": 584.01, "discounted_cash": 93.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 97.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 97.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1913.58, "discounted_cash": 2764.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 375.09, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 141.08, "discounted_cash": 203.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS GU PTHGN ARG DETCJ", "code_information": [{"code": "372U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 384.53, "maximum": 623.8, "discounted_cash": 555.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 576.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 576.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 623.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 576.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 576.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 3 TRGT", "code_information": [{"code": "240U", "type": "CPT"}], "standard_charges": [{"minimum": 128.34, "maximum": 128.34, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 4 TRGT", "code_information": [{"code": "241U", "type": "CPT"}], "standard_charges": [{"minimum": 128.34, "maximum": 128.34, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1125.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NG TUBE 16FR W PREVENT FILTER 0046160", "code_information": [{"code": "46160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.99, "setting": "both", "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3889.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4198.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION", "code_information": [{"code": "19110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 699.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROBLUE TETRAZOLIUM DYE", "code_information": [{"code": "86384", "type": "CPT"}], "standard_charges": [{"minimum": 12.25, "maximum": 584.01, "discounted_cash": 17.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PL NFS IMG", "code_information": [{"code": "64416", "type": "CPT"}], "standard_charges": [{"minimum": 100.03, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEM NRV NFS IMG", "code_information": [{"code": "64448", "type": "CPT"}], "standard_charges": [{"minimum": 93.56, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEMORAL NRV IMG", "code_information": [{"code": "64447", "type": "CPT"}], "standard_charges": [{"minimum": 179.59, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD II IH NERVES", "code_information": [{"code": "64425", "type": "CPT"}], "standard_charges": [{"minimum": 161.17, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD LMBR PLEX NFS", "code_information": [{"code": "64449", "type": "CPT"}], "standard_charges": [{"minimum": 82.17, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRVTG SI JT", "code_information": [{"code": "64451", "type": "CPT"}], "standard_charges": [{"minimum": 320.96, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV 1", "code_information": [{"code": "64420", "type": "CPT"}], "standard_charges": [{"minimum": 142.21, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV EA", "code_information": [{"code": "64421", "type": "CPT"}], "standard_charges": [{"minimum": 47.23, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD OTHER PN/BRANCH", "code_information": [{"code": "64450", "type": "CPT"}], "standard_charges": [{"minimum": 107.89, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 99.38, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PLTR COM DG NRV", "code_information": [{"code": "64455", "type": "CPT"}], "standard_charges": [{"minimum": 67.62, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PUDENDAL NERVE", "code_information": [{"code": "64430", "type": "CPT"}], "standard_charges": [{"minimum": 127.98, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SC NRV NFS IMG", "code_information": [{"code": "64446", "type": "CPT"}], "standard_charges": [{"minimum": 97.62, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SCIATIC NRV IMG", "code_information": [{"code": "64445", "type": "CPT"}], "standard_charges": [{"minimum": 230.5, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SPRSCAP NRV", "code_information": [{"code": "64418", "type": "CPT"}], "standard_charges": [{"minimum": 120.49, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 120.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TRIGEMINAL NRV", "code_information": [{"code": "64400", "type": "CPT"}], "standard_charges": [{"minimum": 159.24, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 105.87, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 105.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1100.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX B1 SUB MTRL SBCHDRL DFCT", "code_information": [{"code": "707T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH NSLC P-ART ANGRP", "code_information": [{"code": "93568", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV LV/LA ANG", "code_information": [{"code": "93565", "type": "CPT"}], "standard_charges": [{"minimum": 34.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV RV/RA ANG", "code_information": [{"code": "93566", "type": "CPT"}], "standard_charges": [{"minimum": 33.99, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SPRVLV AORTGRPHY", "code_information": [{"code": "93567", "type": "CPT"}], "standard_charges": [{"minimum": 48.28, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 48.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"minimum": 124.07, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"minimum": 84.26, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 84.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"minimum": 92.52, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 70.31, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 67.54, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 691.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 240.47, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"minimum": 50.86, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1689.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1758.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PLATELET PLASMA", "code_information": [{"code": "232T", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY CRV/THRC", "code_information": [{"code": "62291", "type": "CPT"}], "standard_charges": [{"minimum": 450.77, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 815.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"minimum": 406.64, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 406.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 212.68, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 158.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NK CELLS TOTAL COUNT", "code_information": [{"code": "86357", "type": "CPT"}], "standard_charges": [{"minimum": 33.96, "maximum": 584.01, "discounted_cash": 49.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1430.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1378.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1754.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1458.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 14.39, "maximum": 584.01, "discounted_cash": 20.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON - INSULATED BIPOLAR 8 1/2", "code_information": [{"code": "20-1410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.26, "setting": "both", "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": 158.07, "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": 9204.53, "maximum": 18679.1, "discounted_cash": 20519.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12328.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12328.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18679.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16365.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10782.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9204.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9681.59, "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": 15077.93, "maximum": 30598.22, "discounted_cash": 32294.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20195.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20195.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30598.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26808.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17663.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15077.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15998.07, "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": 4761.67, "maximum": 9663.03, "discounted_cash": 12181.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6377.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6377.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9663.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8466.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5578.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4761.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6218.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 33654.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 4147.8, "maximum": 9802.53, "discounted_cash": 18419.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5555.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5555.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8417.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7374.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4858.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4147.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9802.53, "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": 7658.51, "maximum": 18776.84, "discounted_cash": 14696.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12392.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12392.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18776.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16451.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10839.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9252.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7658.51, "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": 15632.55, "maximum": 33925.22, "discounted_cash": 30654.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22390.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22390.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33925.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29723.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19583.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16717.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15632.55, "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": 5157.0, "maximum": 12928.09, "discounted_cash": 10722.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8532.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8532.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12928.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11326.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7462.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6370.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5157.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 364.89, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 364.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 364.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 394.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 364.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 364.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4269.31, "maximum": 10713.3, "discounted_cash": 9313.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7070.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7070.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10713.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9386.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6184.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5279.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4269.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2675.57, "maximum": 6848.09, "discounted_cash": 5409.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4519.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4519.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6848.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5999.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3953.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3374.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2675.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-OPHTHALMIC FVA", "code_information": [{"code": "C9733", "type": "HCPCS"}], "standard_charges": [{"minimum": 313.62, "maximum": 339.17, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 339.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 313.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-ROUTINE BL DRAW 3/> YRS", "code_information": [{"code": "36410", "type": "CPT"}], "standard_charges": [{"minimum": 25.38, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-SPEECH DEVICE SERVICE", "code_information": [{"code": "92606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [{"code": "71", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4703.56, "maximum": 11722.27, "discounted_cash": 9173.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7736.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7736.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11722.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10270.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6766.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5776.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4703.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [{"code": "70", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6360.42, "maximum": 12907.44, "discounted_cash": 14885.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8519.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8519.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12907.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11308.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7450.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6360.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7760.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "72", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3348.14, "maximum": 9530.89, "discounted_cash": 6761.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6290.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6290.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9530.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8350.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5501.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4696.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3348.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [{"code": "67", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6493.22, "maximum": 24569.15, "discounted_cash": 13132.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16215.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16215.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24569.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21525.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14182.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12106.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6493.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [{"code": "68", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3934.13, "maximum": 11935.63, "discounted_cash": 7728.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7877.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7877.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11935.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10457.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6889.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5881.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3934.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [{"code": "80", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5708.57, "maximum": 11584.62, "discounted_cash": 16183.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7645.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7645.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11584.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10149.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6687.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5708.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8871.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [{"code": "81", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3224.64, "maximum": 6543.88, "discounted_cash": 8007.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4319.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4319.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6543.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5733.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3777.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3224.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4038.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONVASCULAR SHUNT X-RAY", "code_information": [{"code": "75809", "type": "CPT"}], "standard_charges": [{"minimum": 80.81, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 97.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 97.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOONAN SPECTRUM DISORDERS", "code_information": [{"code": "81442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1929.24, "discounted_cash": 2786.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 812.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 812.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 879.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 812.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 812.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1929.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1929.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"minimum": 787.51, "maximum": 1598.12, "discounted_cash": 1786.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1054.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1054.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1598.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1400.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 922.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 787.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 891.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOS QUANT SENSORY TEST", "code_information": [{"code": "110T", "type": "CPT"}], "standard_charges": [{"minimum": 210.08, "maximum": 226.89, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 210.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 210.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 226.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 210.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 36.6, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVACHOR 1 SQ CM", "code_information": [{"code": "Q4194", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVAFIX DL PER SQ CM", "code_information": [{"code": "Q4254", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVAFIX PER SQ CM", "code_information": [{"code": "Q4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVOSORB SYNPATH PER SQ CM", "code_information": [{"code": "A2006", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE", "code_information": [{"code": "81310", "type": "CPT"}], "standard_charges": [{"minimum": 221.87, "maximum": 584.01, "discounted_cash": 320.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 333.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 333.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 360.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 333.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 333.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 221.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 221.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE ANALYSIS QUAN", "code_information": [{"code": "49U", "type": "CPT"}], "standard_charges": [{"minimum": 221.84, "maximum": 359.92, "discounted_cash": 529.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 359.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 221.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 221.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE BI", "code_information": [{"code": "69706", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3497.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE UNI", "code_information": [{"code": "69705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3375.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRAS GENE VARIANTS EXON 2&3", "code_information": [{"code": "81311", "type": "CPT"}], "standard_charges": [{"minimum": 266.21, "maximum": 584.01, "discounted_cash": 384.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 431.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 399.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC GEN SEQ VRNT ALY 13", "code_information": [{"code": "419U", "type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 1736.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"minimum": 170.2, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 170.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP EA", "code_information": [{"code": "96133", "type": "CPT"}], "standard_charges": [{"minimum": 136.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 11-12 STUDIES", "code_information": [{"code": "95912", "type": "CPT"}], "standard_charges": [{"minimum": 126.61, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 186.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 186.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 186.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 13/> STUDIES", "code_information": [{"code": "95913", "type": "CPT"}], "standard_charges": [{"minimum": 147.18, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 207.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 207.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 224.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 207.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 7-8 STUDIES", "code_information": [{"code": "95910", "type": "CPT"}], "standard_charges": [{"minimum": 102.71, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 151.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 102.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 9-10 STUDIES", "code_information": [{"code": "95911", "type": "CPT"}], "standard_charges": [{"minimum": 114.52, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 176.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 3-4 STUDIES", "code_information": [{"code": "95908", "type": "CPT"}], "standard_charges": [{"minimum": 67.24, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 89.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 89.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 97.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 89.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 5-6 STUDIES", "code_information": [{"code": "95909", "type": "CPT"}], "standard_charges": [{"minimum": 80.81, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG <4CM", "code_information": [{"code": "64892", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1260.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG >4 CM", "code_information": [{"code": "64893", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1341.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT <4CM", "code_information": [{"code": "64890", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1293.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT >4CM", "code_information": [{"code": "64891", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1373.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG <4 CM", "code_information": [{"code": "64897", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1506.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG >4 CM", "code_information": [{"code": "64898", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1632.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT <4 CM", "code_information": [{"code": "64895", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1573.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT >4 CM", "code_information": [{"code": "64896", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1698.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT 1ST", "code_information": [{"code": "64912", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1084.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 195.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "type": "CPT"}], "standard_charges": [{"minimum": 361.22, "maximum": 4936.0, "discounted_cash": 489.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 411.81, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC FRNT TISS RMVL", "code_information": [{"code": "31276", "type": "CPT"}], "standard_charges": [{"minimum": 428.43, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 428.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1240.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1147.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SPHN TISS RMVL", "code_information": [{"code": "31259", "type": "CPT"}], "standard_charges": [{"minimum": 534.95, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SRG NSL HEMRRG", "code_information": [{"code": "31238", "type": "CPT"}], "standard_charges": [{"minimum": 345.78, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG BX POLYPC", "code_information": [{"code": "31237", "type": "CPT"}], "standard_charges": [{"minimum": 353.88, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 353.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT SINS", "code_information": [{"code": "31296", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2108.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT&SPHN", "code_information": [{"code": "31298", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3898.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG MAX SINS", "code_information": [{"code": "31295", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2073.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1412.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG SPHN SINS", "code_information": [{"code": "31297", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2056.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 504.99, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 504.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 566.13, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 566.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/PRTL ETHMDCT", "code_information": [{"code": "31254", "type": "CPT"}], "standard_charges": [{"minimum": 579.7, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 579.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/TOT ETHMDCT", "code_information": [{"code": "31255", "type": "CPT"}], "standard_charges": [{"minimum": 368.03, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3055.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC RF ABLTJ PNN", "code_information": [{"code": "31242", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3146.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC CNCH BULL RESCJ", "code_information": [{"code": "31240", "type": "CPT"}], "standard_charges": [{"minimum": 183.57, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 502.8, "maximum": 4936.0, "discounted_cash": 2225.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 199.56, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 59.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 58.89, "maximum": 584.01, 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66.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 65.87, "maximum": 584.01, "discounted_cash": 291.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDT15 GENE COMMON VARIANTS", "code_information": [{"code": "81306", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 584.01, "discounted_cash": 378.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 425.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDT15&TPMT GENE COM VRNT", "code_information": [{"code": "169U", "type": "CPT"}], "standard_charges": [{"minimum": 419.55, "maximum": 680.61, "discounted_cash": 606.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 680.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDYN DL OR DL MESH PR SQ CM", "code_information": [{"code": "Q4285", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDYN SL OR SLW, PER SQ CM", "code_information": [{"code": "Q4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99379", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUSHIELD 1 SQUARE CM", "code_information": [{"code": "Q4160", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle Biopsy Of Lung Or Chest Tissue, Accessed Through The Skin", "code_information": [{"code": "32405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NeoGuard, per square centimeter", "code_information": [{"code": "Q4371", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL)", "code_information": [{"code": "83884", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 151.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99327", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 30 Minutes", "code_information": [{"code": "99325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Home Visit, Typically 45 Minutes", "code_information": [{"code": "99343", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "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": 31.35, "maximum": 584.01, "gross_charge": 193.0, "discounted_cash": 160.88, "estimated_discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 47.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.35, "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": 5.08, "maximum": 584.01, "gross_charge": 62.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5.08, "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": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nursing Facility Annual Assessment, Typically 30 Minutes", "code_information": [{"code": "99318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [{"code": "620", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7127.41, "maximum": 27510.73, "discounted_cash": 14308.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18157.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18157.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27510.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24103.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15880.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13556.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7127.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [{"code": "619", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12168.37, "maximum": 38025.81, "discounted_cash": 25817.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25097.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25097.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38025.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33315.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21950.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18738.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12168.37, "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": 6524.01, "maximum": 23534.02, "discounted_cash": 13487.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15532.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15532.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23534.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20618.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13585.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11596.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6524.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. 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"BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "413U", "type": "CPT"}], "standard_charges": [{"minimum": 1137.18, "maximum": 1137.18, "discounted_cash": 1642.59, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "414U", "type": "CPT"}], "standard_charges": [{"minimum": 635.63, "maximum": 635.63, "discounted_cash": 918.13, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBALON BALLON METHYLENE BLUE 0.0006% 500 ML NACL 0.9%", "code_information": [{"code": "MED0132", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80055", "type": "CPT"}], "standard_charges": [{"minimum": 43.03, "maximum": 584.01, "discounted_cash": 62.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 81.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 75.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 67.37, "maximum": 584.01, "discounted_cash": 97.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 137.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 137.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 137.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 137.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2875.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2875.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59409", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 937.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1266.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1266.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBTAINING SCREEN PAP SMEAR", "code_information": [{"code": "Q0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.69, "maximum": 61.46, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBTURATOR ENDO 5MM SEALED RIGHT VERSAPORT V2 STRL DISP", "code_information": [{"code": "179101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.21, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR VERSAPORT PLUA 12MM VZ RT SEAL", "code_information": [{"code": "179103P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 301.26, "setting": "both", "billing_class": "facility"}]}, {"description": "OCCLUDE FALLOPIAN TUBE(S)", "code_information": [{"code": "58615", "type": "CPT"}], "standard_charges": [{"minimum": 300.79, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 300.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE DEVICE IN VEIN ART", "code_information": [{"code": "G0269", "type": "HCPCS"}], "standard_charges": [{"minimum": 1044.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD FECES 1-3 TESTS", "code_information": [{"code": "82272", "type": "CPT"}], "standard_charges": [{"minimum": 3.81, "maximum": 584.01, "discounted_cash": 5.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD OTHER SOURCES", "code_information": [{"code": "82271", "type": "CPT"}], "standard_charges": [{"minimum": 4.79, "maximum": 584.01, "discounted_cash": 6.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R BILATERAL", "code_information": [{"code": "486T", "type": "CPT"}], "standard_charges": [{"minimum": 42.93, "maximum": 46.43, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R UNILATERAL", "code_information": [{"code": "485T", "type": "CPT"}], "standard_charges": [{"minimum": 42.93, "maximum": 46.43, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"minimum": 94.98, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 94.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 94.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 102.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 94.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR FUNCTION SCREEN", "code_information": [{"code": "99172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99174", "type": "CPT"}], "standard_charges": [{"minimum": 25.42, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99177", "type": "CPT"}], "standard_charges": [{"minimum": 25.42, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "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": 20.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"minimum": 382.65, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 382.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 697.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1524.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1320.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX 70MIN", "code_information": [{"code": "G2086", "type": "HCPCS"}], "standard_charges": [{"minimum": 669.55, "maximum": 669.55, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, 60 M", "code_information": [{"code": "G2087", "type": "HCPCS"}], "standard_charges": [{"minimum": 607.02, "maximum": 607.02, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 607.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, ADD30", "code_information": [{"code": "G2088", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.38, "maximum": 82.38, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST LOW 30", "code_information": [{"code": "99243", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST MOD 40", "code_information": [{"code": "99244", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST HI 55", "code_information": [{"code": "99245", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST SF 20", "code_information": [{"code": "99242", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP EST MAY X REQ PHY/QHP", "code_information": [{"code": "99211", "type": "CPT"}], "standard_charges": [{"minimum": 32.57, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE EMERGENCY CARE", "code_information": [{"code": "99058", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST HI 40 MIN", "code_information": [{"code": "99215", "type": "CPT"}], "standard_charges": [{"minimum": 260.68, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST LOW 20 MIN", "code_information": [{"code": "99213", "type": "CPT"}], "standard_charges": [{"minimum": 128.86, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST MOD 30 MIN", "code_information": [{"code": "99214", "type": "CPT"}], "standard_charges": [{"minimum": 183.65, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST SF 10 MIN", "code_information": [{"code": "99212", "type": "CPT"}], "standard_charges": [{"minimum": 79.93, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW HI 60 MIN", "code_information": [{"code": "99205", "type": "CPT"}], "standard_charges": [{"minimum": 319.3, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 319.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW LOW 30 MIN", "code_information": [{"code": "99203", "type": "CPT"}], "standard_charges": [{"minimum": 158.26, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 158.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW MOD 45 MIN", "code_information": [{"code": "99204", "type": "CPT"}], "standard_charges": [{"minimum": 239.57, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW SF 15 MIN", "code_information": [{"code": "99202", "type": "CPT"}], "standard_charges": [{"minimum": 101.33, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFLOXACIN (FLOXIN) 0.3%  5ML OTIC", "code_information": [{"code": "MED0162", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.52, "setting": "both", "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 11-20 MIN", "code_information": [{"code": "99422", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 21+ MIN", "code_information": [{"code": "99423", "type": "CPT"}], "standard_charges": [{"minimum": 66.53, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 5-10 MIN", "code_information": [{"code": "99421", "type": "CPT"}], "standard_charges": [{"minimum": 21.31, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": 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"code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1802.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1761.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2092.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2248.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2293.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 946.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1042.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BX/EXC INGUINOFEM NODES", "code_information": [{"code": "38531", "type": "CPT"}], "standard_charges": [{"minimum": 566.3, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 566.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1012.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 274.31, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 274.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1493.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 221.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/NEUROMUSCULAR 64580", "code_information": [{"code": "64580", "type": "CPT"}, {"code": "1481075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 411.07, "maximum": 8117.0, "gross_charge": 3387.0, "discounted_cash": 24255.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/PERIPHERAL NERVE 64575", "code_information": [{"code": "64575", "type": "CPT"}, {"code": "1481076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 391.81, "maximum": 8117.0, "gross_charge": 3387.0, "discounted_cash": 13931.72, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 391.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/SACRAL 64581", "code_information": [{"code": "64581", "type": "CPT"}, {"code": "1481077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 3387.0, "discounted_cash": 7968.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 791.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 932.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 833.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2535.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2466.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61314", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2265.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2551.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2325.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2617.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2037.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2480.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT AND/OR REDUCTION OF VERTERAL FX 22325", "code_information": [{"code": "22325", "type": "CPT"}, {"code": "1700063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1856.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT/REDUCTION VERTEBRAL FX/DISLOCATION; POST. 1 FRACTURE 22326", "code_information": [{"code": "22326", "type": "CPT"}, {"code": "23984959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1888.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1630.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1301.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 882.72, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE & SEPTAL FX", "code_information": [{"code": "21335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX UNCOMPLICATD", "code_information": [{"code": "21325", "type": "CPT"}], "standard_charges": [{"minimum": 549.32, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 549.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX W/SKELE FIXJ", "code_information": [{"code": "21330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 1634.36, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1634.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX SEPTAL FX W/WO STABJ", "code_information": [{"code": "21336", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 775.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1000.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1007.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3411.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1595.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2179.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4299.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 42.3, "maximum": 68.62, "discounted_cash": 61.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 63.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 57.61, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 72.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 72.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 78.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 72.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 72.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 23.89, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 39.66, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 29.16, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 23.46, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 105.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 105.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 113.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 105.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"minimum": 96.67, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 25.22, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOID &OPIATE ANALOG 5/MORE", "code_information": [{"code": "80364", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 352.18, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 352.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 443.23, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 152.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 241.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"minimum": 320.86, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"minimum": 463.73, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 463.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 397.6, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 14067.0, "discounted_cash": 55071.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBF", "code_information": [{"code": "817T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 24255.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBQ", "code_information": [{"code": "816T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 24255.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 38581.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 971.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1511.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 626.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD ZYGOMATIC ARCH", "code_information": [{"code": "21356", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 782.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1254.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1217.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1272.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 930.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX PERIORBITAL", "code_information": [{"code": "21386", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 836.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 893.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1080.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/IMPLANT", "code_information": [{"code": "21407", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 774.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/O IMPLANT", "code_information": [{"code": "21406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1190.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBTL IMPLT", "code_information": [{"code": "21390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 950.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPPS SERVICE,SCHED TEAM CONF", "code_information": [{"code": "G0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 711.06, "maximum": 767.94, "discounted_cash": 521.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 711.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 711.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 767.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 711.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"minimum": 21.5, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"minimum": 34.19, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 46.13, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 61.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 61.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 61.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 61.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"minimum": 37.46, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 4.64, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX ACRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23552", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 809.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX ACROMCLV DISLC AQT/CHRN", "code_information": [{"code": "23550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 715.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX ACUTE SHOULDER DISLC", "code_information": [{"code": "23660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 729.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX CLAVICULAR FX W/INT FIX", "code_information": [{"code": "23515", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 896.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX GR HMRL TBRS FX INT FIX", "code_information": [{"code": "23630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX MEDIAL ANKLE FX", "code_information": [{"code": "27766", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX POST ANKLE FX", "code_information": [{"code": "27769", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 893.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX PROX HUMRL FX W/INT FIX", "code_information": [{"code": "23615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1087.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX PRX HMRL FX FIX RPR RPL", "code_information": [{"code": "23616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1482.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX SCAPULAR FX W/INT FIXJ", "code_information": [{"code": "23585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1183.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC FX", "code_information": [{"code": "23670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1079.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1141.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 787.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OR CABLES 1X16 SC-4166", "code_information": [{"code": "SC-4166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 116.02, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 165.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 165.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 178.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 165.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0435", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.78, "maximum": 22.81, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 98.29, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 139.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 139.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 150.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 139.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 98.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9591.84, "maximum": 19465.09, "discounted_cash": 21022.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12847.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12847.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19465.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17054.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11236.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9591.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10071.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5275.71, "maximum": 14166.94, "discounted_cash": 12097.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9350.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9350.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14166.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12412.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8178.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6981.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5275.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3615.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4135.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3870.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY PARTIAL", "code_information": [{"code": "54522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY (FOWLER-STEPHENS)", "code_information": [{"code": "54650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 874.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY INGUN/SCROT APPR", "code_information": [{"code": "54640", "type": "CPT"}], "standard_charges": [{"minimum": 530.41, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID SINGLE QUANT", "code_information": [{"code": "83921", "type": "CPT"}], "standard_charges": [{"minimum": 19.09, "maximum": 584.01, "discounted_cash": 27.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL EACH", "code_information": [{"code": "83919", "type": "CPT"}], "standard_charges": [{"minimum": 14.81, "maximum": 584.01, "discounted_cash": 21.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS TOTAL QUANT", "code_information": [{"code": "83918", "type": "CPT"}], "standard_charges": [{"minimum": 21.24, "maximum": 584.01, "discounted_cash": 30.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [{"code": "884", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4659.92, "maximum": 9456.56, "discounted_cash": 14385.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6241.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6241.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9456.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8285.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5458.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4659.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7454.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORION, PER SQ CM", "code_information": [{"code": "Q4276", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHC/PROSTC MGMT SBSQ ENC", "code_information": [{"code": "97763", "type": "CPT"}], "standard_charges": [{"minimum": 67.6, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 90.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 90.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 98.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 90.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING PFRMD PHYS/QHP", "code_information": [{"code": "92065", "type": "CPT"}], "standard_charges": [{"minimum": 53.2, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING SUPVJ PHYS/QHP", "code_information": [{"code": "92066", "type": "CPT"}], "standard_charges": [{"minimum": 34.41, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 10CM MATCH HEAD 3MM DIAMETER MR8-10MH30", "code_information": [{"code": "MR8-10MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 342.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 12CM TELESC MATCH 2.5MM DIAM MR8-T12MH25", "code_information": [{"code": "MR8-T12MH25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 14CM CYLINDER 5MM DIAMETER LONG  MR8-14CY50L", "code_information": [{"code": "MR8-14CY50L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 14CM CYLINDER 5MM DIAMETER MR8-14CY50", "code_information": [{"code": "MR8-14CY50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 14CM MATCH HEAD 3MM DIAMETER MR8-14MH30", "code_information": [{"code": "MR8-14MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 15CM MATCH HEAD 2.2MM DIAMETER MR8-15MH22", "code_information": [{"code": "MR8-15MH22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.47, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 9CM DIAM WHEEL 25.4MM DIAMETER MR8-9MC254", "code_information": [{"code": "MR8-9MC254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 9CM MTL CUT 3MM DIAMETR CARBIDE MR8-9MC30", "code_information": [{"code": "MR8-9MC30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPAEDIC BUR TOOL MR8 F2/7CM TAPER 2.3MM DIAMETER MR8-F2/7TA23", "code_information": [{"code": "MR8-F2/7TA23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOPOXVIRUS AMP PRB EACH", "code_information": [{"code": "87593", "type": "CPT"}], "standard_charges": [{"minimum": 46.05, "maximum": 584.01, "discounted_cash": 66.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOTIC MGMT&TRAING 1ST ENC", "code_information": [{"code": "97760", "type": "CPT"}], "standard_charges": [{"minimum": 62.42, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSCILLATING TRACKING TEST", "code_information": [{"code": "92545", "type": "CPT"}], "standard_charges": [{"minimum": 4.64, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8663.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8663.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 857.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE ALLOGRAFT", "code_information": [{"code": "27415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1660.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE AUTOGRAFT", "code_information": [{"code": "27416", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1190.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL TALUS AUTOGRFT", "code_information": [{"code": "28446", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1485.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5775.57, "maximum": 13488.32, "discounted_cash": 11590.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8902.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8902.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13488.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11817.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7786.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6646.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5775.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9025.97, "maximum": 19668.81, "discounted_cash": 17611.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12981.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12981.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19668.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17232.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11354.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9692.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9025.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3904.68, "maximum": 8821.99, "discounted_cash": 7040.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5822.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5822.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8821.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7729.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5092.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4347.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3904.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"minimum": 43.91, "maximum": 584.01, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"minimum": 62.73, "maximum": 584.01, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 62.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"minimum": 82.73, "maximum": 584.01, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"minimum": 100.23, "maximum": 584.01, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"minimum": 117.49, "maximum": 584.01, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"minimum": 413.22, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1936.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2254.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY OF SPINE POSTERIOR OR POSTEROLATERAL APPROACH 1 VERTEBRAL SEGMENT EA. ADD. SEGMENT 22216", "code_information": [{"code": "22216", "type": "CPT"}, {"code": "42887889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 414.36, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY OF SPINE POSTERIOR OR POSTEROLATERAL APPROACH 1 VERTEBRAL SEGMENT LUMBAR 22214", "code_information": [{"code": "22214", "type": "CPT"}, {"code": "42887891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1872.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY OF SPINE W/DISCECTOMY SINGLE CERVICAL 22220", "code_information": [{"code": "22220", "type": "CPT"}, {"code": "1481507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2015.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CH", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320161", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CI", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320162", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CJ", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320163", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CK", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320164", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CL", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320165", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CM", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320166", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS CURRENT  G8981 CN", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45320167", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CH", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320175", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CI", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320176", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CJ", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320177", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CK", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320178", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CL", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320179", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CM", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320180", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS DC  G8983 CN", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45320181", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CH", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320168", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CI", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320169", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CJ", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320170", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CK", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320171", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CL", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320172", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CM", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320173", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT BODY POS GOAL  G8982 CN", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45320174", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Body Position Goal Status G-8982 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "16164932", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CH", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320182", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CI", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320183", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CJ", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320184", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CK", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320185", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CL", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320186", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CM", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320187", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY CURRENT  G8984 CN", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45320188", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CH", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320196", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CI", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320197", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CJ", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320198", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CK", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320199", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CL", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320200", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CM", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320201", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY DC  G8986 CN", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45320202", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CH", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320189", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CI", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320190", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CJ", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320191", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CK", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320192", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CL", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320193", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320194", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT CARRY GOAL  G8985 CN", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45320195", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Carry Goal Status G-8985 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16164954", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT EVAL HIGH COMPLEX 60 MIN", "code_information": [{"code": "97167", "type": "CPT"}], "standard_charges": [{"minimum": 138.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT EVAL LOW COMPLEX 30 MIN", "code_information": [{"code": "97165", "type": "CPT"}], "standard_charges": [{"minimum": 138.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT EVAL MOD COMPLEX 45 MIN", "code_information": [{"code": "97166", "type": "CPT"}], "standard_charges": [{"minimum": 138.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 148.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT MOBILITY CURRENT  G8978 CI", "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CH", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320154", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CI", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320155", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CJ", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320156", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CK", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320157", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CL", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320158", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CM", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320159", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY DC  G8980 CN", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45320160", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CH", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320144", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CI", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320146", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CJ", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320147", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CK", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320150", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CL", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320151", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CM", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320152", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT MOBILITY GOAL  G8979 CN", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45320153", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Current Status G-9168 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G9168", "type": "HCPCS"}, {"code": "16164959", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CH 0% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164969", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164968", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164967", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164966", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CL At least 60% but less than 80% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164965", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164964", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CN 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164963", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CH", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320224", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CI", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320225", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CJ", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320226", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CK", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320227", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CL", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320228", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CM", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320229", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER CURRENT  G8990 CN", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320230", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER DISCHARGE  G8992 CH", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320238", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER DISCHARGE  G8992 CI", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320239", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER DISCHARGE  G8992 CJ", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320240", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER DISCHARGE  G8992 CK", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320241", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER DISCHARGE  G8992 CL", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320242", "type": "CDM"}, {"code": "430", 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"type": "HCPCS"}, {"code": "45320232", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER GOAL  G8991 CJ", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320233", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER GOAL  G8991 CK", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320234", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER GOAL  G8991 CL", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320235", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT OTHER 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PROCEDURES WITH MCC", "code_information": [{"code": "831", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5136.91, "maximum": 14151.8, "discounted_cash": 10751.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9340.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9340.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14151.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12398.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8169.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6973.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5136.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2319.87, "maximum": 6611.33, "discounted_cash": 4675.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4363.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4363.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6611.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5792.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3816.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3257.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2319.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3204.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22240.47, "maximum": 100798.34, "discounted_cash": 44236.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66527.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66527.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 100798.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 88312.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 58186.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 49670.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22240.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13863.42, "maximum": 66347.3, "discounted_cash": 28160.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43789.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43789.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66347.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58129.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 38299.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 32694.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13863.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4294.74, "maximum": 13975.6, "discounted_cash": 8613.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9224.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9224.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13975.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12244.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8067.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6886.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4294.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9451.43, "maximum": 19180.15, "discounted_cash": 18644.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12659.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12659.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19180.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16804.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11071.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9451.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9611.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3046.89, "maximum": 11290.05, "discounted_cash": 6098.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7451.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7451.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11290.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9891.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6517.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5563.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3046.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15598.63, "maximum": 43028.01, "discounted_cash": 29869.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28398.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28398.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43028.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37698.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24838.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21202.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15598.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4201.02, "maximum": 11785.59, "discounted_cash": 8366.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7778.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7778.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11785.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10325.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6803.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5807.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4201.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7390.73, "maximum": 18183.56, "discounted_cash": 14299.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12001.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12001.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18183.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15931.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10496.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8960.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7390.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2840.25, "maximum": 9711.21, "discounted_cash": 5802.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6409.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6409.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9711.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8508.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5605.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4785.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2840.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. 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PROCEDURES WITH MCC", "code_information": [{"code": "515", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13801.38, "maximum": 64636.31, "discounted_cash": 28495.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42660.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42660.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64636.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 56630.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 37312.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 31850.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13801.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. 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"OVULATION TESTS", "code_information": [{"code": "84830", "type": "CPT"}], "standard_charges": [{"minimum": 11.43, "maximum": 584.01, "discounted_cash": 16.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", 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"PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 12533.89, "maximum": 29775.07, "discounted_cash": 25931.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19651.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19651.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29775.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26086.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17187.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14672.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12533.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20485.34, "maximum": 41571.68, "discounted_cash": 48913.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27437.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27437.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41571.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36422.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23997.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20485.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24228.29, "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": 9532.08, "maximum": 25366.14, "discounted_cash": 19846.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16741.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16741.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25366.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22224.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14642.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12499.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9532.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2305.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3483.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3738.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3499.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1647.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANEL FLEXIBLE ELASTIC RIGID POSTERIOR L0641", "code_information": [{"code": "L0641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PANEL LSO SAG-CORONAL CONTROL RIGID ANT/POST  L0650", "code_information": [{"code": "L0650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2643.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": [{"minimum": 11.97, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANTY MESH", "code_information": [{"code": "6100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER HIGH DENSITY 210 X 25MM BLACK AND WHITE", "code_information": [{"code": "UPP210-HD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER TABLE 21 X 3.5IN TMC", "code_information": [{"code": "62080-545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPER TE SEALS DO NOT USE  8001", "code_information": [{"code": "8001", "type": "CDM"}], "standard_charges": [{"gross_charge": 17.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PAPPA SERUM", "code_information": [{"code": "84163", "type": "CPT"}], "standard_charges": [{"minimum": 13.55, "maximum": 584.01, "discounted_cash": 19.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAFFIN BATH THERAPY", "code_information": [{"code": "97018", "type": "CPT"}], "standard_charges": [{"minimum": 7.96, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAINFLUENZA AG IF", "code_information": [{"code": "87279", "type": "CPT"}], "standard_charges": [{"minimum": 14.79, "maximum": 584.01, "discounted_cash": 21.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 408.89, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 443.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 443.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 479.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 443.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 443.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/WO SUBTRJ", "code_information": [{"code": "78071", "type": "CPT"}], "standard_charges": [{"minimum": 334.47, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 360.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 360.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 360.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 360.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 334.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROID PLANAR IMAGING", "code_information": [{"code": "78070", "type": "CPT"}], "standard_charges": [{"minimum": 293.94, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 319.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 319.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 346.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 319.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 319.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SUPP NOT OTHRWS C", "code_information": [{"code": "B9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING/CUTG B9 HYPRKER LES 1", "code_information": [{"code": "11055", "type": "CPT"}], "standard_charges": [{"minimum": 92.89, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "type": "CPT"}], "standard_charges": [{"minimum": 107.82, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "type": "CPT"}], "standard_charges": [{"minimum": 118.32, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 118.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 589.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 962.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1208.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF ANKLE/HEEL", "code_information": [{"code": "28120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 914.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 622.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 632.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 643.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28113", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 781.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1091.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL AMPUTATION OF TOE", "code_information": [{"code": "28825", "type": "CPT"}], "standard_charges": [{"minimum": 387.58, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 387.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC BONE HUMERUS", "code_information": [{"code": "24140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC. POSTERIOR VERTEBRAL COMPONENT 22103", "code_information": [{"code": "22103", "type": "CPT"}, {"code": "45571552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 152.95, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC. POSTERIOR VERTEBRAL COMPONENT FOR BONY LESION SINGLE THORACIC 22101", "code_information": [{"code": "22101", "type": "CPT"}, {"code": "45571553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 3387.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1123.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC. VERTEBRAL BODY FOR BONY LESION W/O DEC. SPINE/NERVE RT. SINGLE SEG. EA . ADD. 22116", "code_information": [{"code": "22116", "type": "CPT"}, {"code": "19352184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 161.35, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 661.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 688.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT FOR INTRINSIC BONY LESION; CERVICAL 22100", "code_information": [{"code": "22100", "type": "CPT"}, {"code": "44761767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1269.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION POSTERIOR VERTEBRAL 22102", "code_information": [{"code": "22102", "type": "CPT"}, {"code": "1481560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 3387.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION VERTEBRAL BODY CERVICAL W/O DECOMPRESSION 22110", "code_information": [{"code": "22110", "type": "CPT"}, {"code": "1481566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1316.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1152.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL MASTECTOMY", "code_information": [{"code": "19301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 827.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2280.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1375.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1253.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL COLLAR BONE", "code_information": [{"code": "23120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4359.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5194.56, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5194.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5702.94, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5702.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 614.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26236", "type": "CPT"}], "standard_charges": [{"minimum": 558.08, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 558.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FOOT FASCIA", "code_information": [{"code": "28060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL LEG BONE(S)", "code_information": [{"code": "27360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1129.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1171.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1523.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1638.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2215.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2007.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2144.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1997.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2554.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2318.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5987.59, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5987.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3961.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4387.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3503.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3056.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5461.1, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5461.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67005", "type": "CPT"}], "standard_charges": [{"minimum": 559.11, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FIBULA", "code_information": [{"code": "27641", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 800.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 814.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HAND BONE", "code_information": [{"code": "26230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 623.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2459.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3027.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HYMEN", "code_information": [{"code": "56700", "type": "CPT"}], "standard_charges": [{"minimum": 241.71, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 241.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1607.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2572.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2836.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2424.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2307.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2277.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2485.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 749.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2835.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3692.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3952.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1836.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 955.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1906.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1985.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3756.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PENIS", "code_information": [{"code": "54120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1678.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25230", "type": "CPT"}], "standard_charges": [{"minimum": 547.14, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1336.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2200.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1892.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1546.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF SCAPULA", "code_information": [{"code": "23190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": [{"code": "21620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 656.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1124.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TIBIA", "code_information": [{"code": "27640", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28124", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28126", "type": "CPT"}], "standard_charges": [{"minimum": 516.18, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 516.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28153", "type": "CPT"}], "standard_charges": [{"minimum": 532.56, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 532.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28160", "type": "CPT"}], "standard_charges": [{"minimum": 543.27, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1300.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1579.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25119", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 641.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 706.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25240", "type": "CPT"}], "standard_charges": [{"minimum": 543.11, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF VULVA", "code_information": [{"code": "56620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1238.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 855.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60212", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1268.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY SCRN", "code_information": [{"code": "86403", "type": "CPT"}], "standard_charges": [{"minimum": 10.39, "maximum": 584.01, "discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK 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"standard_charges": [{"minimum": 229.55, "maximum": 584.01, "discounted_cash": 331.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 351.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 351.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 351.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 351.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PCV13 VACCINE IM", "code_information": [{"code": "90670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PCV15 VACCINE IM", "code_information": [{"code": "90671", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee 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PREFERRED", "standard_charge_dollar": 481.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES PHYS/QHP", "code_information": [{"code": "96573", "type": "CPT"}], "standard_charges": [{"minimum": 286.28, "maximum": 584.01, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 350.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 350.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 378.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 350.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES SKN", "code_information": [{"code": "96567", "type": "CPT"}], "standard_charges": [{"minimum": 169.25, "maximum": 1270.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 237.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 237.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 256.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 237.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI", "code_information": [{"code": "165U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 417.38, "discounted_cash": 602.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI CLIN RX", "code_information": [{"code": "178U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 413.87, "discounted_cash": 597.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 INIT", "code_information": [{"code": "99475", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 658.37, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 SUBSQ", "code_information": [{"code": "99476", "type": "CPT"}], "standard_charges": [{"minimum": 420.76, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 420.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT", "code_information": [{"code": "99466", "type": "CPT"}], "standard_charges": [{"minimum": 280.41, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT ADDL", "code_information": [{"code": "99467", "type": "CPT"}], "standard_charges": [{"minimum": 140.49, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE INITIAL", "code_information": [{"code": "99471", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 935.8, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 935.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE SUBSQ", "code_information": [{"code": "99472", "type": "CPT"}], "standard_charges": [{"minimum": 485.64, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 485.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC COMPL", "code_information": [{"code": "94774", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC DOWNLD", "code_information": [{"code": "94776", "type": "CPT"}], "standard_charges": [{"minimum": 393.38, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 393.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 393.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 424.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 393.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC HK-UP", "code_information": [{"code": "94775", "type": "CPT"}], "standard_charges": [{"minimum": 83.24, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 83.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 83.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 89.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 83.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC REPORT", "code_information": [{"code": "94777", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED VSCLTS KD ALYS 3 BMRKS", "code_information": [{"code": "310U", "type": "CPT"}], "standard_charges": [{"minimum": 351.68, "maximum": 351.68, "discounted_cash": 507.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED WHL GEN MTHYLTN ALYS 50+", "code_information": [{"code": "318U", "type": "CPT"}], "standard_charges": [{"minimum": 1593.43, "maximum": 1593.43, "discounted_cash": 2301.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDCLE FH/CH/CH/M/N/AX/G/H/F", "code_information": [{"code": "15574", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1165.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDICLE E/N/E/L/NTRORAL", "code_information": [{"code": "15576", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1060.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9384.8, "maximum": 21085.23, "discounted_cash": 19045.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13916.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13916.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21085.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18473.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12171.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10390.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9384.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC", "code_information": [{"code": "735", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5417.64, "maximum": 17193.86, "discounted_cash": 12030.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11348.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11348.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17193.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15064.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9925.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8472.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5417.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "57410", "type": "CPT"}], "standard_charges": [{"minimum": 128.64, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "99459", "type": "CPT"}], "standard_charges": [{"minimum": 22.77, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3314.91, "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": 410.78, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 410.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1290.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1219.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENCAN SPINAL TRAYS & NEEDLES BMG333868", "code_information": [{"code": "BMG333868", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL CAUTERY ELECTROSURGICAL PUSH BTN CYGNUS SERIES SS", "code_information": [{"code": "ESPB2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.08, "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": 56.27, "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": 37.32, "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": 14.59, "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": 37.32, "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": 28.47, "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": 53.31, "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": 70.81, "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": 70.81, "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": 14.59, "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": 53.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 79.94, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 117.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 68.55, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 94.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 94.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 101.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 94.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 596.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGERY", "code_information": [{"code": "54360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 881.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10028.81, "maximum": 22208.45, "discounted_cash": 20807.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14657.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14657.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22208.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19457.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12820.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10943.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10028.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6700.75, "maximum": 17875.23, "discounted_cash": 12528.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11797.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11797.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17875.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15661.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10318.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8808.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6700.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 60.94, "maximum": 4936.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 19.08, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT 65+ YR", "code_information": [{"code": "99397", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT INFANT", "code_information": [{"code": "99391", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC CRYO ABLATE RENAL TUM", "code_information": [{"code": "50593", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4620.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG S", "code_information": [{"code": "C9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT SING", "code_information": [{"code": "C9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3454.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4533.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 4.69, "maximum": 584.01, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17451.67, "maximum": 48864.37, "discounted_cash": 36887.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32250.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32250.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48864.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42811.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28207.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 24078.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17451.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13929.02, "maximum": 33307.17, "discounted_cash": 29432.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21982.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21982.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33307.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29181.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19226.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16412.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13929.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES", "code_information": [{"code": "321", 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INCL. CAVITY CREATION MECH. DEVICE 1 VERT.UNI OR BIL. THORACIC 22513", "code_information": [{"code": "22513", "type": "CPT"}, {"code": "1481592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 7618.16, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7618.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR MULTIPLE 22515", "code_information": [{"code": "22515", "type": "CPT"}, {"code": "1481591", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3908.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-IMPLT CAPSLC BRST COMPL", "code_information": [{"code": "19371", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 860.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEVICE EVAL & PRGR", "code_information": [{"code": "93287", "type": "CPT"}], "standard_charges": [{"minimum": 22.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI-PX EVAL PM/LDLS PM IP", "code_information": [{"code": "93286", "type": "CPT"}], "standard_charges": [{"minimum": 20.96, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERICAPSULAR INJECTION 100 ML", "code_information": [{"code": "MED0156", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"minimum": 268.57, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 268.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4778.09, "maximum": 14293.58, "discounted_cash": 9544.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9433.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9433.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14293.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12523.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8251.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7043.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4778.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7219.35, "maximum": 22289.66, "discounted_cash": 14598.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14711.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14711.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22289.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19528.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12866.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10983.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7219.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3183.9, "maximum": 13935.69, "discounted_cash": 6435.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9197.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9197.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13935.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12209.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8044.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6867.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3183.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 19.96, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.96, "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": 10078.35, "maximum": 24271.82, "discounted_cash": 19659.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16019.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16019.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24271.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21265.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14011.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11960.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10078.35, "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": 16834.88, "maximum": 63894.38, "discounted_cash": 34524.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42170.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42170.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 63894.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55980.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36883.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 31485.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 16834.88, "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": 7844.17, "maximum": 23807.94, "discounted_cash": 15447.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15713.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15713.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23807.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20858.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13743.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11731.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7844.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9427.19, "maximum": 26415.03, "discounted_cash": 18854.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17434.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17434.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26415.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23143.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15248.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13016.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9427.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16171.23, "maximum": 54737.9, "discounted_cash": 31928.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36127.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36127.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54737.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47957.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31598.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26973.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 16171.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6851.15, "maximum": 17170.46, "discounted_cash": 13724.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11332.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11332.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17170.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15043.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9911.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8461.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6851.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"minimum": 125.96, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERM FLP TUBE OCCLS W/IMPLT", "code_information": [{"code": "567T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [{"code": "243", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10054.25, "maximum": 56446.14, "discounted_cash": 19053.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37254.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37254.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 56446.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49454.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32584.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 27815.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10054.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15138.5, "maximum": 69089.29, "discounted_cash": 28547.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45599.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45599.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69089.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60531.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 39882.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 34045.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15138.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8054.38, "maximum": 37299.02, "discounted_cash": 16161.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24617.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24617.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37299.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32678.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21531.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18379.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8054.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMEADERM B, PER SQ CM", "code_information": [{"code": "A2016", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMEADERM C, PER SQ CM", "code_information": [{"code": "A2018", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 10.64, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 7656.83, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7656.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"minimum": 144.42, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 977.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CERVICOTHORACIC INJECT", "code_information": [{"code": "22510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2325.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"minimum": 333.15, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"minimum": 463.31, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 463.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 240.5, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 240.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"minimum": 378.11, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 378.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 312.93, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 218.71, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 7968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LUMBOSACRAL INJECTION", "code_information": [{"code": "22511", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2338.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1355.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 852.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 883.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 671.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"minimum": 337.44, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 337.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4596.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5230.93, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5230.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5212.07, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5212.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 244.81, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 3881.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 1423.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 843.41, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 912.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 453.13, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 826.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 826.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 893.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 826.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 453.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2026.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1876.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1037.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2261.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2261.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2442.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2261.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1257.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML CORONRY LITHOTRP", "code_information": [{"code": "92972", "type": "CPT"}], "standard_charges": [{"minimum": 169.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 591.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 885.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 25.39, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2233.38, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2233.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1488.91, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"maximum": 2233.38, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2233.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2065.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2977.85, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2977.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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"standard_charge_dollar": 1376.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2977.85, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2977.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2753.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGING INITIAL DX", "code_information": [{"code": "G0252", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.26, "maximum": 108.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 100.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMG WHOLBOD MELANO NONCO", "code_information": [{"code": "G0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PFA FUNC ASA", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "1233832", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 22.42, "maximum": 584.01, "gross_charge": 25.0, "discounted_cash": 32.38, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 39.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 39.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 39.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHARMACOLOGIC MGMT W/PSYTX", "code_information": [{"code": "90863", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CLT ADD", "code_information": [{"code": "87904", "type": "CPT"}], "standard_charges": [{"minimum": 23.46, "maximum": 584.01, "discounted_cash": 33.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 48.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 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"standard_charges": [{"minimum": 439.79, "maximum": 973.29, "discounted_cash": 635.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 899.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 899.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 973.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 899.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 899.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 439.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 439.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE INFECT AGENT DRUG", "code_information": [{"code": "87900", "type": "CPT"}], "standard_charges": [{"minimum": 117.32, "maximum": 584.01, "discounted_cash": 169.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 240.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 240.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 259.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 240.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 240.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 117.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 117.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE 2.5% OPHTHALMIC DROPS/MYDFRIN 3ML", "code_information": [{"code": "MED0170", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 66.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE REG-ST SPR 0.5% 15ML", "code_information": [{"code": "MED0171", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.96, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE/NEOSYNEPHRINE 100MCG/ML 5ML", "code_information": [{"code": "MED0172", "type": "CDM"}], "standard_charges": [{"gross_charge": 15.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PHLEB VEINS - EXTREM 20+", "code_information": [{"code": "37766", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY", "code_information": [{"code": "99195", "type": "CPT"}], "standard_charges": [{"minimum": 128.25, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 176.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 176.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 176.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOENIX WND MTRX, PER SQ CM", "code_information": [{"code": "A2015", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 11-20 MIN", "code_information": [{"code": "99442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 21-30 MIN", "code_information": [{"code": "99443", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 5-10 MIN", "code_information": [{"code": "99441", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHOLIPID PLTLT NEUTRALIZ", "code_information": [{"code": "85597", "type": "CPT"}], "standard_charges": [{"minimum": 16.18, "maximum": 584.01, "discounted_cash": 23.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 7.7, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY UV-A OR B", "code_information": [{"code": "96913", "type": "CPT"}], "standard_charges": [{"minimum": 192.54, "maximum": 584.01, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 226.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 226.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 244.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 226.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 192.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-A", "code_information": [{"code": "96912", "type": "CPT"}], "standard_charges": [{"minimum": 127.04, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"minimum": 124.54, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 124.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 124.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 134.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 124.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTODYNAMIC TX ADDL 15 MIN", "code_information": [{"code": "96571", "type": "CPT"}], "standard_charges": [{"minimum": 36.54, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 72.13, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 107.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 72.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1793.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 67.5, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHP/IOP OT SERVICE", "code_information": [{"code": "G0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/MNTR", "code_information": [{"code": "94626", "type": "CPT"}], "standard_charges": [{"minimum": 144.36, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/O MNTR", "code_information": [{"code": "94625", "type": "CPT"}], "standard_charges": [{"minimum": 115.39, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 115.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 20.69, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 70.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 70.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 70.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 70.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS REVIEW OF MOTION TESTS", "code_information": [{"code": "96004", "type": "CPT"}], "standard_charges": [{"minimum": 145.87, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 46.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICIAN STANDBY SERVICES", "code_information": [{"code": "99360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1121.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1634.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1610.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1693.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1551.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"minimum": 421.81, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 421.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 584.01, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 487.94, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILL SPLITTER NON135000", "code_information": [{"code": "NON135000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW ABDUCTION CONTOURED LARGE", "code_information": [{"code": "APG201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW ABDUCTION CONTOURED MEDIUM", "code_information": [{"code": "APG202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW ABDUCTION CONTOURED SMALL", "code_information": [{"code": "APG203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW FILLED 18IN X 24IN TAN POLYESTER NYLEX II", "code_information": [{"code": "MDT219716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW REUSABLE 20IN X 26IN TAN FLUID RESISTANT POLYESTER FILLED NYLEX II", "code_information": [{"code": "MDT219715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% OPHTHALMIC SOLUTION 15 ML", "code_information": [{"code": "MED0173", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 223.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 100MM STERILE PERC REF", "code_information": [{"code": "9733235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 783.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 150MM STERILE PERC REF", "code_information": [{"code": "9733236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 14MM DISTRACTION", "code_information": [{"code": "MDS9091414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISPENSING MULTI ACCESS MINI SPIKE LF", "code_information": [{"code": "412012 PIN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 12MM ANT CERVICAL FUSION", "code_information": [{"code": "909-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 12MM BLUE CASPAR ANT CERVICAL FUSION TI", "code_information": [{"code": "DP-12-TB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 14MM TI STRL", "code_information": [{"code": "DP-14-TY", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL HEADLESS TROCAR KNEE", "code_information": [{"code": "-5901-020-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL QUICK RELEASE PATELLOFEMORAL REPLACE SYS VANGUARD STRL", "code_information": [{"code": "32-486265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FINGER DISLOCATION", "code_information": [{"code": "26776", "type": "CPT"}], "standard_charges": [{"minimum": 574.71, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 574.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN FINGER FRACTURE EACH", "code_information": [{"code": "26756", "type": "CPT"}], "standard_charges": [{"minimum": 547.77, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN FXTN 80MM SPEED NONRIMMED SS IMP", "code_information": [{"code": "74013490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FXTN THREADED HEADLESS SIGMA STRL", "code_information": [{"code": "9505-02-302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2201.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GENESIS TROCHLEAR 1/8 X 3 71210002", "code_information": [{"code": "71210002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HAND DISLOCATION", "code_information": [{"code": "26676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN KNUCKLE DISLOCATION", "code_information": [{"code": "26706", "type": "CPT"}], "standard_charges": [{"minimum": 555.33, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN MIS 3.2MM X 45MM  74016465", "code_information": [{"code": "74016465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN O-ARM PIN 3.1MM THREADED SHARP", "code_information": [{"code": "500842", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PATIENT REF 4X150 451611035", "code_information": [{"code": "451611035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN RADIOULNAR DISLOCATION", "code_information": [{"code": "25671", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 688.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SCHANZ 150MM KIT0001799", "code_information": [{"code": "KIT0001799", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2181.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SERVICE 60M PER MONTH", "code_information": [{"code": "G0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.39, "maximum": 117.39, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SHOULDER 70MM 309605", "code_information": [{"code": "309605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SRV ADD 30 MIN PR M", "code_information": [{"code": "G0024", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.54, "maximum": 73.54, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN THREADED HP HEADED STRL", "code_information": [{"code": "950502303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2201.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREADED HP STRL", "code_information": [{"code": "950502302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2201.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ULNAR STYLOID FRACTURE", "code_information": [{"code": "25651", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS ADULT SKULL  A1072", "code_information": [{"code": "A1072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}], "standard_charges": [{"minimum": 3.84, "maximum": 584.01, "discounted_cash": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.84, "maximum": 6.23, "discounted_cash": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 521.53, "maximum": 1154.45, "discounted_cash": 753.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1067.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1067.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1154.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1067.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1067.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 109.03, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 17230.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1141.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3074.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1651.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2506.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2013.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2344.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1250.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2990.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 355.86, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 355.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 743.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 988.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1402.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1419.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2591.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 301.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 301.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 674.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1029.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1063.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 981.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1293.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 782.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1288.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1043.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 385.59, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 385.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 559.73, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 559.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 528.38, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 528.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 10219.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5239.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARKER PROS", "code_information": [{"code": "55876", "type": "CPT"}], "standard_charges": [{"minimum": 202.77, "maximum": 4936.0, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 202.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1360.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2773.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON", "code_information": [{"code": "46020", "type": "CPT"}], "standard_charges": [{"minimum": 146.84, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACENTAL LACTOGEN", "code_information": [{"code": "83632", "type": "CPT"}], "standard_charges": [{"minimum": 18.2, "maximum": 584.01, "discounted_cash": 26.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLAELET RICH PLASMA UNIT", "code_information": [{"code": "P9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 331.88, "maximum": 358.43, "discounted_cash": 685.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 331.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 331.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 358.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 331.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA FRESH FROZEN", "code_information": [{"code": "86927", "type": "CPT"}], "standard_charges": [{"minimum": 16.94, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA PROTEIN FRACT,5%,50ML", "code_information": [{"code": "P9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.54, "maximum": 36.22, "discounted_cash": 9.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 108.03, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 108.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 108.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 108.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 108.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 82.47, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMAPROTEIN FRACT,5%,250ML", "code_information": [{"code": "P9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.06, "maximum": 79.98, "discounted_cash": 43.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 79.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY NECK", "code_information": [{"code": "15819", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 35X27 8MM SPIN PLATE 21-11-3508", "code_information": [{"code": "21-11-3508", "type": "CDM"}], "standard_charges": [{"gross_charge": 10000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 6190042 ANTERIOR CERVICAL 42.5MM 6190042", "code_information": [{"code": "6190042", "type": "CDM"}], "standard_charges": [{"gross_charge": 3800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8MM 15-5108", "code_information": [{"code": "15-5108", "type": "CDM"}], "standard_charges": [{"gross_charge": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8MM 15-5814", "code_information": [{"code": "15-5814", "type": "CDM"}], "standard_charges": [{"gross_charge": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 8MM 15-5814.", "code_information": [{"code": "15-5814.", "type": "CDM"}], "standard_charges": [{"gross_charge": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS FOUR LEVEL 70MM 7200170", "code_information": [{"code": "7200170", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ONE LEVEL 32.5MM 7200132", "code_information": [{"code": "7200132", "type": "CDM"}], "standard_charges": [{"gross_charge": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS TWO LEVEL 27.5MM 7200127", "code_information": [{"code": "7200127", "type": "CDM"}], "standard_charges": [{"gross_charge": 3800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 10MM MED POST BODY COMPONENT IMP", "code_information": [{"code": "6212-0010-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 16000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 12MM MED POST BODY COMPONENT IMP", "code_information": [{"code": "6212-0012-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 16000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BONE 6MM MED POST BODY COMPONENT IMP", "code_information": [{"code": "6212-0006-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 16000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 30MM MED POST BODY TI IMP", "code_information": [{"code": "6262-0108-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 12800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 35MM MED POST BODY TI IMP", "code_information": [{"code": "6262-1108-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 12800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L 45MM MED POST BODY TI IMP", "code_information": [{"code": "6262-2108-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 12800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE L MED 55MM POST BODY TI IMP", "code_information": [{"code": "6262-3108-003", "type": "CDM"}], "standard_charges": [{"gross_charge": 12800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OC ADJUSTABLE INFINITY OCCIPITAL  3600601", "code_information": [{"code": "3600601", "type": "CDM"}], "standard_charges": [{"gross_charge": 8000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PYRAMID 3-HOLE 41MM 9873141", "code_information": [{"code": "9873141", "type": "CDM"}], "standard_charges": [{"gross_charge": 11000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PYRAMID 4-HOLE 39MM 9874039", "code_information": [{"code": "9874039", "type": "CDM"}], "standard_charges": [{"gross_charge": 11000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE PYRAMID 4-HOLE 45MM 9874045", "code_information": [{"code": "9874045", "type": "CDM"}], "standard_charges": [{"gross_charge": 11000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ROI-C AWL STARTER - LONG MC9095R-S", "code_information": [{"code": "MC9095R-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ROI-C AWL STARTER - SHORT MC9096R-S", "code_information": [{"code": "MC9096R-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO FOUR LEVEL 67MM 3004067", "code_information": [{"code": "3004067", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO FOUR LEVEL 78MM 3004078", "code_information": [{"code": "3004078", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO FOUR LEVEL 83MM 3004083", "code_information": [{"code": "3004083", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO FOUR LEVEL 86MM 3004086", "code_information": [{"code": "3004086", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO FOUR LEVEL 89MM 3004089", "code_information": [{"code": "3004089", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO ONE LEVEL 27MM 3001027", "code_information": [{"code": "3001027", "type": "CDM"}], "standard_charges": [{"gross_charge": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO ONE LEVEL 29MM  3001029", "code_information": [{"code": "3001029", "type": "CDM"}], "standard_charges": [{"gross_charge": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO THREE LEVEL 43MM 3003043", "code_information": [{"code": "3003043", "type": "CDM"}], "standard_charges": [{"gross_charge": 4000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO THREE LEVEL 68MM 3003068", "code_information": [{"code": "3003068", "type": "CDM"}], "standard_charges": [{"gross_charge": 4000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO THREE LEVEL 71MM 3003071", "code_information": [{"code": "3003071", "type": "CDM"}], "standard_charges": [{"gross_charge": 4000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO TWO LEVEL 27MM 3002027", "code_information": [{"code": "3002027", "type": "CDM"}], "standard_charges": [{"gross_charge": 3800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO TWO LEVEL 29MM 3002029", "code_information": [{"code": "3002029", "type": "CDM"}], "standard_charges": [{"gross_charge": 3800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ZEVO TWO LEVEL 48MM 3002048", "code_information": [{"code": "3002048", "type": "CDM"}], "standard_charges": [{"gross_charge": 3800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATELET ANTIBODIES", "code_information": [{"code": "86022", "type": "CPT"}], "standard_charges": [{"minimum": 16.53, "maximum": 584.01, "discounted_cash": 23.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET PHERESIS IRRADIATED", "code_information": [{"code": "P9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 1168.34, "maximum": 1261.81, "discounted_cash": 1161.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1168.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1168.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1261.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1168.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET SURVIVAL", "code_information": [{"code": "78191", "type": "CPT"}], "standard_charges": [{"minimum": 134.21, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 185.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOCYTES REDUCED", "code_information": [{"code": "P9031", "type": "HCPCS"}], "standard_charges": [{"minimum": 236.54, "maximum": 255.46, "discounted_cash": 176.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOREDUCED IRRAD", "code_information": [{"code": "P9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 321.66, "maximum": 347.39, "discounted_cash": 232.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 321.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 321.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 347.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 321.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS, HLA-M, L/R, UNIT", "code_information": [{"code": "P9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 1563.56, "maximum": 1688.64, "discounted_cash": 866.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1563.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1563.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1688.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1563.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS, IRRADIATED", "code_information": [{"code": "P9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 336.84, "maximum": 363.79, "discounted_cash": 480.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 336.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 336.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 363.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 336.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS, PHERESIS", "code_information": [{"code": "P9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 804.44, "maximum": 868.8, "discounted_cash": 378.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 804.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 804.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 868.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 804.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS, PHERESIS (APHERESIS), LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT, P9037", "code_information": [{"code": "P9037", "type": "HCPCS"}, {"code": "45850893", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 1339.34, "maximum": 1446.49, "gross_charge": 784.05, "discounted_cash": 832.92, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1339.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1339.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1446.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1339.34, "methodology": "fee schedule"}], "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": 2808.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 584.01, "discounted_cash": 378.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 425.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 393.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4480.85, "maximum": 11046.41, "discounted_cash": 8843.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7290.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7290.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11046.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9678.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6376.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5443.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4480.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7051.54, "maximum": 18895.22, "discounted_cash": 13935.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12470.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12470.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18895.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16554.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10907.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9311.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7051.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3276.73, "maximum": 9711.21, "discounted_cash": 6412.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6409.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6409.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9711.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8508.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5605.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4785.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3276.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1564.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1470.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1142.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1421.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 457.36, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 457.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 382.56, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 382.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1250.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1403.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1685.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 377.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 377.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT, APH/PHER, L/R, CMV-NEG", "code_information": [{"code": "P9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 865.12, "maximum": 934.33, "discounted_cash": 306.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 865.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 865.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 934.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 865.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT, PHER, L/R CMV-NEG, IRR", "code_information": [{"code": "P9053", "type": "HCPCS"}], "standard_charges": [{"minimum": 1400.84, "maximum": 1512.91, "discounted_cash": 616.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1400.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1400.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1512.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1400.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL DUAL", "code_information": [{"code": "93280", "type": "CPT"}], "standard_charges": [{"minimum": 35.12, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL MULTI", "code_information": [{"code": "93281", "type": "CPT"}], "standard_charges": [{"minimum": 40.9, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM PHONE R-STRIP DEVICE EVAL", "code_information": [{"code": "93293", "type": "CPT"}], "standard_charges": [{"minimum": 34.84, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 72.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 67.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA 1 BREAKPOINT", "code_information": [{"code": "81316", "type": "CPT"}], "standard_charges": [{"minimum": 186.58, "maximum": 629.83, "discounted_cash": 269.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 582.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 582.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 629.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 582.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 582.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA COM BREAKPOINTS", "code_information": [{"code": "81315", "type": "CPT"}], "standard_charges": [{"minimum": 186.58, "maximum": 584.01, "discounted_cash": 269.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 381.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 381.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 412.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 381.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 381.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE DUP/DELET", "code_information": [{"code": "81324", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 682.52, "discounted_cash": 985.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 682.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 682.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE FULL SEQUENCE", "code_information": [{"code": "81325", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 692.62, "discounted_cash": 1000.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 692.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 692.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE KNOWN FAM VARIANT", "code_information": [{"code": "81326", "type": "CPT"}], "standard_charges": [{"minimum": 41.94, "maximum": 584.01, "discounted_cash": 60.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 41.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 41.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE DUP/DELET VARIANTS", "code_information": [{"code": "81319", "type": "CPT"}], "standard_charges": [{"minimum": 183.15, "maximum": 584.01, "discounted_cash": 264.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 299.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 299.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 323.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 299.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 299.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE FULL SEQ ANALYSIS", "code_information": [{"code": "81317", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1140.68, "discounted_cash": 879.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1054.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1054.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1140.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1054.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1054.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 KNOWN FAMILIAL VARIANTS", "code_information": [{"code": "81318", "type": "CPT"}], "standard_charges": [{"minimum": 249.22, "maximum": 584.01, "discounted_cash": 430.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 249.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 249.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 249.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 249.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 MRNA SEQ ALYS", "code_information": [{"code": "161U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 254.59, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCYSTIS CARINII AG IF", "code_information": [{"code": "87281", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4942.77, "maximum": 10305.86, "discounted_cash": 9829.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6801.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6801.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10305.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9029.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5949.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5078.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4942.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7878.53, "maximum": 16831.84, "discounted_cash": 15773.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11109.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11109.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16831.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14746.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9716.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8294.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7878.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [{"code": "201", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3021.9, "maximum": 7994.71, "discounted_cash": 6393.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5276.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5276.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7994.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7004.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4615.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3939.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3021.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNXR ASPIR ABSC HMTMA BULLA", "code_information": [{"code": "10160", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 174.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [{"code": "917", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6913.23, "maximum": 14029.29, "discounted_cash": 14023.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9259.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9259.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14029.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12291.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8098.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6913.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7317.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [{"code": "918", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2538.88, "maximum": 5152.24, "discounted_cash": 7663.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3400.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3400.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5152.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4514.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2974.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2538.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3947.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLIOVIRUS IPV SC/IM", "code_information": [{"code": "90713", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYETHYLENE VIVACIT-E / ARTICULAR SURFACE / MEDIAL CONGRUENT/ L 11MM HEIGHT 42-4121-010-11", "code_information": [{"code": "42-4121-010-11", "type": "CDM"}], "standard_charges": [{"gross_charge": 100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYMYXIN B SULF  500MU VIAL", "code_information": [{"code": "MED0174", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.14, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYMYXIN B SULFATE 500,000 UNITS VIAL", "code_information": [{"code": "MED0175", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.14, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYSOM 6/> YRS 4/> PARAM", "code_information": [{"code": "95810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 890.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 890.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 961.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 890.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM 6/>YRS CPAP 4/> PARM", "code_information": [{"code": "95811", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 935.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 935.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1010.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 935.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 763.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS 4/> PARAMTRS", "code_information": [{"code": "95782", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1600.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1600.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1728.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1600.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1161.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS CPAP/BILVL", "code_information": [{"code": "95783", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1700.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1700.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1836.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1700.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1225.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM ANY AGE 1-3> PARAM", "code_information": [{"code": "95808", "type": "CPT"}], "standard_charges": [{"minimum": 562.88, "maximum": 1858.0, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 985.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 985.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1064.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 985.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 562.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYVALENT MULT ORG EA AG IA", "code_information": [{"code": "87451", "type": "CPT"}], "standard_charges": [{"minimum": 9.46, "maximum": 584.01, "discounted_cash": 13.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POOLING BLOOD PLATELETS", "code_information": [{"code": "86965", "type": "CPT"}], "standard_charges": [{"minimum": 27.8, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORT PLUG IPG SPECTRA", "code_information": [{"code": "SC-4401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.65, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1725.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92532", "type": "CPT"}], "standard_charges": [{"minimum": 34.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"minimum": 5.08, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONER HD 6IN X 10.75IN X 9.75IN RASPBERRY FRM REST FOAM LATEX WITHOUT COVER", "code_information": [{"code": "NON081146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.99, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HD 6IN X 10.75IN X 9.75IN RASPBERRY FRM REST FOAM WITHOUT COVER LF", "code_information": [{"code": "NON081147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.34, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD 8 X 9 X 1/4 CRADLE LF ADLT", "code_information": [{"code": "8815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.68, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD FOAM ADULT 9 X 8 X 4.5IN", "code_information": [{"code": "NON081144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.12, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONING DEVICE GASTRISAIL 36FR GASTRIC BARIATRIC", "code_information": [{"code": "GPS36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1865.05, "setting": "both", "billing_class": "facility"}]}, {"description": "POST D/C H VST NEW PT 20 M", "code_information": [{"code": "G2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.51, "maximum": 68.51, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 68.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST OP SERVICE LVRS MIN 6", "code_information": [{"code": "G0305", "type": "HCPCS"}], "standard_charges": [{"minimum": 1805.96, "maximum": 1950.44, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1950.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.5, "maximum": 36.5, "discounted_cash": 32.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, 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"billing_class": "facility"}]}, {"description": "POWDER SURGIFOAM PORCINE STRL 1978", "code_information": [{"code": "1978", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PPP2R2B GEN DETC ABNOR ALLEL", "code_information": [{"code": "81343", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PPPS, INITIAL VISIT", "code_information": [{"code": "G0438", "type": "HCPCS"}], "standard_charges": [{"minimum": 236.89, "maximum": 236.89, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 236.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PPPS, SUBSEQ VISIT", "code_information": [{"code": "G0439", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PPSV23 VACC 2 YRS+ SUBQ/IM", "code_information": [{"code": "90732", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"minimum": 329.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 329.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 281.98, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 281.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 1-9 DOS", "code_information": [{"code": "G0304", "type": "HCPCS"}], "standard_charges": [{"minimum": 1805.96, "maximum": 1950.44, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1950.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 10-15DOS", "code_information": [{"code": "G0303", "type": "HCPCS"}], "standard_charges": [{"minimum": 272.64, "maximum": 294.45, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS COMPLETE", "code_information": [{"code": "G0302", "type": "HCPCS"}], "standard_charges": [{"minimum": 1805.96, "maximum": 1950.44, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1950.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1805.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15259.04, "maximum": 30965.74, "discounted_cash": 36292.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20437.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20437.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30965.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27130.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17875.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15259.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18119.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2446.63, "maximum": 10933.01, "discounted_cash": 21899.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3276.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3276.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4965.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4350.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2866.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2446.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10933.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "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": 31.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 448.71, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 320.59, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 448.38, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 384.02, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"minimum": 275.44, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 275.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 221.95, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 212.64, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"minimum": 254.43, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 254.43, "methodology": "fee schedule"}], "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": 22.99, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 47.43, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 245.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 438.22, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 438.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 438.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 473.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 438.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1233.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2952.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2044.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2322.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2136.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2010.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1894.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2162.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21085", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 949.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2189.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2189.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2185.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 148.05, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 148.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 223.52, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 193.17, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 193.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPUTIAL STRETCHING", "code_information": [{"code": "54450", "type": "CPT"}], "standard_charges": [{"minimum": 96.22, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"minimum": 254.74, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 254.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 15", "code_information": [{"code": "99401", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 30", "code_information": [{"code": "99402", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 45", "code_information": [{"code": "99403", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 60", "code_information": [{"code": "99404", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 1-4", "code_information": [{"code": "99392", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 12-17", "code_information": [{"code": "99394", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 18-39", "code_information": [{"code": "99395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 40-64", "code_information": [{"code": "99396", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 5-11", "code_information": [{"code": "99393", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 12-17", "code_information": [{"code": "99384", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 18-39", "code_information": [{"code": "99385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 40-64", "code_information": [{"code": "99386", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 5-11", "code_information": [{"code": "99383", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99411", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ICDS SS IP", "code_information": [{"code": "575T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 39.96, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 45.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 30.62, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 28.04, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 35.76, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 50.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 42.2, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 47.98, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 58.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "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": 584.01, "maximum": 6923.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2148.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 605.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX", "code_information": [{"code": "Q4110", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99424", "type": "CPT"}], "standard_charges": [{"minimum": 119.09, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99425", "type": "CPT"}], "standard_charges": [{"minimum": 83.68, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 83.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF 1ST 30", "code_information": [{"code": "99426", "type": "CPT"}], "standard_charges": [{"minimum": 92.0, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF EA ADDL", "code_information": [{"code": "99427", "type": "CPT"}], "standard_charges": [{"minimum": 73.14, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE 9569645 BAYON BALL LONG STR 9569645", "code_information": [{"code": "9569645", "type": "CDM"}], "standard_charges": [{"gross_charge": 695.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE APSN100 REUSE NITINL 100M 16G-22G APSN100", "code_information": [{"code": "APSN100", "type": "CDM"}], "standard_charges": [{"gross_charge": 12443.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE APSN150 REUSE NITINL 150MM 16G-22G APSN150", "code_information": [{"code": "APSN150", "type": "CDM"}], "standard_charges": [{"gross_charge": 12443.2, "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": 597.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE COVER  ROLLED  LATEX  1.4 X8  VPC0109", "code_information": [{"code": "VPC0109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MMG BALL TIP  2860-02-206", "code_information": [{"code": "2860-02-206", "type": "CDM"}], "standard_charges": [{"gross_charge": 1700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68810", "type": "CPT"}], "standard_charges": [{"minimum": 215.02, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 215.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68811", "type": "CPT"}], "standard_charges": [{"minimum": 158.88, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 158.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68815", "type": "CPT"}], "standard_charges": [{"minimum": 497.24, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 497.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE NEUROMONITORING MONOPOLAR STRL", "code_information": [{"code": "3.809.692S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1838.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NL DUCT W/BALLOON", "code_information": [{"code": "68816", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE ORAL 4FT CORD FOR SURETEMP 678 THEROMETER", "code_information": [{"code": "2678-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE PEDICLE 23 CM BALL TIP DISP", "code_information": [{"code": "9450015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SENSOR DIGITAL DURASENSOR ADLT", "code_information": [{"code": "DS100A-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SENTIO MMG BALL TIP ADJUSTABLE PROBE", "code_information": [{"code": "2862-02-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1717.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE TEMPTURESENSOR STETHSCOPE18F ES400-18", "code_information": [{"code": "ES400-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBES TEMPERATURE SKIN PROBE 400 SERIES DYNJASK400SK", "code_information": [{"code": "DYNJASK400SK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCALCITONIN (PCT)", "code_information": [{"code": "84145", "type": "CPT"}], "standard_charges": [{"minimum": 24.5, "maximum": 584.01, "discounted_cash": 35.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "type": "CPT"}], "standard_charges": [{"minimum": 321.71, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 317.51, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 317.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DILATE", "code_information": [{"code": "45303", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1347.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DX", "code_information": [{"code": "45300", "type": "CPT"}], "standard_charges": [{"minimum": 195.91, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"minimum": 309.28, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 309.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45308", "type": "CPT"}], "standard_charges": [{"minimum": 297.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 297.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45309", "type": "CPT"}], "standard_charges": [{"minimum": 306.28, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 306.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45315", "type": "CPT"}], "standard_charges": [{"minimum": 329.24, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 329.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"minimum": 128.06, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/BX", "code_information": [{"code": "45305", "type": "CPT"}], "standard_charges": [{"minimum": 261.39, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 261.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"minimum": 143.55, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 143.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGENAMATRIX, PER SQ CM", "code_information": [{"code": "Q4222", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC 1ST HR", "code_information": [{"code": "99415", "type": "CPT"}], "standard_charges": [{"minimum": 30.04, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC EA ADD", "code_information": [{"code": "99416", "type": "CPT"}], "standard_charges": [{"minimum": 16.45, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG IP/OBS E/M EA 15 MIN", "code_information": [{"code": "99418", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG OP E/M EACH 15 MIN", "code_information": [{"code": "99417", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG HOME EVAL ADD 15M", "code_information": [{"code": "G0318", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.43, "maximum": 46.43, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG INPT EVAL ADD15 M", "code_information": [{"code": "G0316", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.31, "maximum": 47.31, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG NURSIN FAC EVAL 15M", "code_information": [{"code": "G0317", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.17, "maximum": 46.17, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG OUTPT/OFFICE VIS", "code_information": [{"code": "G2212", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.43, "maximum": 46.43, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, ADDL 30M", "code_information": [{"code": "G0514", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.81, "maximum": 88.81, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, FIRST 30M", "code_information": [{"code": "G0513", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.81, "maximum": 88.81, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERV W/O CONTACT ADD", "code_information": [{"code": "99359", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERVICE W/O CONTACT", "code_information": [{"code": "99358", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPARACAINE 0.5% OPHTH 15ML", "code_information": [{"code": "MED0222", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 75.52, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT CRTX DTHRM", "code_information": [{"code": "67141", "type": "CPT"}], "standard_charges": [{"minimum": 361.87, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT PC", "code_information": [{"code": "67145", "type": "CPT"}], "standard_charges": [{"minimum": 329.04, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 329.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE BIOPSY, ANY MTHD", "code_information": [{"code": "G0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.35, "maximum": 611.78, "discounted_cash": 448.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 565.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 565.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 611.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 565.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 565.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE CA SCREENING; DRE", "code_information": [{"code": "G0102", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.57, "maximum": 32.57, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 887.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE SATURATION SAMPLING", "code_information": [{"code": "55706", "type": "CPT"}], "standard_charges": [{"minimum": 275.36, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 275.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY (TURP)", "code_information": [{"code": "52601", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 709.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7351.9, "maximum": 20222.16, "discounted_cash": 15641.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13346.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13346.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20222.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17717.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11673.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9964.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7351.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14510.87, "maximum": 29447.46, "discounted_cash": 27907.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19435.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19435.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29447.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25799.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16998.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14510.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15324.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4004.0, "maximum": 8125.48, "discounted_cash": 9890.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5362.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5362.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8125.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7119.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4690.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4004.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4587.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC MICROWAVE THERMOTX", "code_information": [{"code": "53850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1883.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOTX", "code_information": [{"code": "53852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1843.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 14067.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTECTOR ORTHO SM MED 2.5 CM TO 8 CMINCISIONS ALEXIS", "code_information": [{"code": "HR004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR ORTHO SM/SM 2.5CM TO 8CM INCISIONS ALEXIS", "code_information": [{"code": "HR001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 747.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR ULNAR CONV FOAM LOW 36PR CS NON081340E", "code_information": [{"code": "NON081340E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR WOUND EXTRA SM 2 CM TO 4 CM RETRACTOR ALEXIS", "code_information": [{"code": "C8312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTECTOR WOUND EXTRA-SMALL WPXSM24", "code_information": [{"code": "WPXSM24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 23.6, "maximum": 584.01, "discounted_cash": 34.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 41.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 41.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN E-PHORESIS SERUM", "code_information": [{"code": "84165", "type": "CPT"}], "standard_charges": [{"minimum": 9.67, "maximum": 584.01, "discounted_cash": 13.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TEST", "code_information": [{"code": "84182", "type": "CPT"}], "standard_charges": [{"minimum": 26.29, "maximum": 584.01, "discounted_cash": 37.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TISSUE", "code_information": [{"code": "88371", "type": "CPT"}], "standard_charges": [{"minimum": 20.01, "maximum": 584.01, "discounted_cash": 28.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEXIS LATEX CLASSIC; STERILE LATEX POWDER-FREE SURGICAL GLOVES WITH NITRILE COATING, SIZE 6", "code_information": [{"code": "2D72N60X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PROTEXIS LATEX CLASSIC; STERILE LATEX POWDER-FREE SURGICAL GLOVES WITH 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "UNITED 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NETWORK EX", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT INTERMEDIATE", "code_information": [{"code": "77523", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 748.32, "discounted_cash": 1562.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 691.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 691.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 748.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 691.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 691.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/COMP", "code_information": [{"code": "77522", "type": "CPT"}], "standard_charges": [{"minimum": 556.27, "maximum": 601.59, "discounted_cash": 1562.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 601.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/O COMP", "code_information": [{"code": "77520", "type": "CPT"}], "standard_charges": [{"minimum": 420.59, "maximum": 584.01, "discounted_cash": 690.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 420.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 420.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 454.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 420.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 420.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA ANTIBODY NOS", "code_information": [{"code": "86753", "type": "CPT"}], "standard_charges": [{"minimum": 11.15, "maximum": 584.01, "discounted_cash": 16.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVIDE INR TEST MATER/EQUIP", "code_information": [{"code": "G0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.07, "maximum": 86.07, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT BLOCK >5 YR", "code_information": [{"code": "49507", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 741.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT REDUC >5 YR", "code_information": [{"code": "49505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 662.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 534.43, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 11943.11, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11943.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 10550.88, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10550.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT 1 ART", "code_information": [{"code": "92924", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC 1VSL", "code_information": [{"code": "92943", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 833.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC ADDL", "code_information": [{"code": "92944", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC MI 1 VSL", "code_information": [{"code": "92941", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 774.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO 1 VSL", "code_information": [{"code": "92928", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 608.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO ADDL", "code_information": [{"code": "92929", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92933", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 727.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92934", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", "type": "CPT"}], "standard_charges": [{"minimum": 508.62, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 508.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"minimum": 107.16, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 333.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 333.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 359.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 333.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT 1 VSL", "code_information": [{"code": "92937", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 688.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE OLECRN PROCESS", "code_information": [{"code": "24147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 114.11, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 206.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 206.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 223.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 206.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.38, "maximum": 36.63, "discounted_cash": 25.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSEUDOANEURYSM INJECTION TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"minimum": 201.33, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 419.55, "discounted_cash": 606.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1202.48, "discounted_cash": 1736.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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"type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 1736.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "411U", "type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 1736.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC MOOD DO MRNA 144 GENES", "code_information": [{"code": "291U", "type": "CPT"}], "standard_charges": [{"minimum": 1579.5, "maximum": 1579.5, "discounted_cash": 2281.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"minimum": 1579.5, "maximum": 1579.5, "discounted_cash": 2281.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC SUICIDAL IDEA MRNA 54", "code_information": [{"code": "293U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 684.0, "discounted_cash": 988.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAG EVAL W/MED SRVCS", "code_information": [{"code": "90792", "type": "CPT"}], "standard_charges": [{"minimum": 280.07, "maximum": 584.01, "discounted_cash": 221.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, 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"code_information": [{"code": "90785", "type": "CPT"}], "standard_charges": [{"minimum": 20.71, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS EA ADDL 30 MIN", "code_information": [{"code": "90840", "type": "CPT"}], "standard_charges": [{"minimum": 108.27, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 108.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": 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"OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 235.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 30 MIN", "code_information": [{"code": "90833", "type": "CPT"}], "standard_charges": [{"minimum": 113.07, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 113.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 45 MIN", "code_information": [{"code": "90836", "type": "CPT"}], "standard_charges": [{"minimum": 143.36, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CH", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319938", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CI", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319939", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CJ", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319940", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CK", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319941", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CL", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319942", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CM", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319943", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS CURRENT  G8981 CN", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "45319944", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CH", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319952", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CI", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319953", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CJ", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319954", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CK", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319955", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CL", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319956", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CM", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319957", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS DC  G8983 CN", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "45319958", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CH", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319945", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CI", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319946", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CJ", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319947", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CK", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319948", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CL", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319949", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CM", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319950", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT BODY POS GOAL  G8982 CN", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "45319951", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Body Position Current Status G-8981 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "16165083", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Body Position Goal Status G-8982 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "16165100", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CH", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319959", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CI", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319960", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CJ", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319961", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CK", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319962", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CL", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319963", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CM", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319964", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY CURRENT  G8984 CN", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "45319965", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CH", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319973", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CI", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319974", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CJ", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319975", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CK", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319976", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CL", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319977", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CM", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319978", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY DC  G8986 CN", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "45319979", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CH", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319966", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CI", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319967", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CJ", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319968", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CK", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319969", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CL", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319970", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319971", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT CARRY GOAL  G8985 CN", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "45319972", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CH 0% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165123", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CI At least 1% but less than 20% impaired", "code_information": [{"code": "16165122", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CJ At least 20% but less than 40% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165121", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CK At least 40% but less than 60% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165120", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CL At least 60% but less than 80% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165119", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165118", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Carry Goal Status G-8985 -> CN 100% impaired", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "16165117", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT Complexity -> High", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "44642247", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 135.29, "maximum": 584.01, "gross_charge": 140.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 165.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Complexity -> Low", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "44642246", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 135.29, "maximum": 584.01, "gross_charge": 140.0, "estimated_discounted_cash": 140.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 165.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Complexity -> Moderate", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "44642245", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 135.29, "maximum": 584.01, "gross_charge": 140.0, "estimated_discounted_cash": 140.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 165.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CH", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319931", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CI", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319932", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CJ", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319933", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CK", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319934", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CL", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319935", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CM", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319936", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY DC  G8980 CN", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "45319937", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CH", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319924", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CI", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319925", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CJ", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319926", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CK", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319927", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CL", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319928", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CM", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319929", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT MOBILITY GOAL  G8979 CN", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "45319930", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CH", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320001", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CI", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320002", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CJ", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320003", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CK", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320004", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CL", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320005", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CM", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320006", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER CURRENT  G8990 CN", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "45320007", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CH", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320015", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CI", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320016", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CJ", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320017", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CK", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320018", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CL", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320019", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CM", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320020", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER DISCHARGE  G8992 CN", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "45320021", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CH", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320008", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CI", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320009", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CJ", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320010", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CK", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320011", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CL", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320012", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CM", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320013", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT OTHER GOAL  G8991 CN", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "45320014", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97164", "type": "CPT"}], "standard_charges": [{"minimum": 92.46, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 103.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 103.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 111.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 103.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 92.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CH", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319994", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CI", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319995", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CJ", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319996", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CK", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319997", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CL", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319998", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CM", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45319999", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE DC  G8989 CN", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "45320000", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CH", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319987", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CI", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319988", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CJ", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319989", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CK", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319990", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CL", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319991", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CM", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319992", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SELF CARE GOAL  G8988 CN", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "45319993", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CH", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320022", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CI", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320023", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CJ", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320024", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CK", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320025", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CL", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320026", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CM", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320027", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB CURRENT  G8993 CN", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "45320028", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CH", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320036", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CI", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320037", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CJ", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320038", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CK", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320039", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CL", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320040", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CM", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320041", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB DC  G8995 CN", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "45320042", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CH", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320029", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CI", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320030", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CJ", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320031", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CK", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320032", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CL", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320033", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CM", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320034", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT SUB GOAL  G8994 CN", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "45320035", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"minimum": 3.94, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER TRAING HOME INR", "code_information": [{"code": "93792", "type": "CPT"}], "standard_charges": [{"minimum": 94.47, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCA W/ PLCMT BRACHYTX DEV", "code_information": [{"code": "C7533", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTEN FULL GENE ANALYSIS", "code_information": [{"code": "235U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 540.0, "discounted_cash": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE DUP/DELET VARIANT", "code_information": [{"code": "81323", "type": "CPT"}], "standard_charges": [{"minimum": 118.26, "maximum": 584.01, "discounted_cash": 390.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 118.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE FULL SEQUENCE", "code_information": [{"code": "81321", "type": "CPT"}], "standard_charges": [{"minimum": 540.0, "maximum": 877.02, "discounted_cash": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 810.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 810.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 877.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 810.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 810.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE KNOWN FAM VARIANT", "code_information": [{"code": "81322", "type": "CPT"}], "standard_charges": [{"minimum": 41.94, "maximum": 584.01, "discounted_cash": 60.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 78.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 78.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 85.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 78.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 78.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 41.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 41.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "633794", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.41, "maximum": 584.01, "gross_charge": 5.0, "discounted_cash": 7.81, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92997", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 726.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 362.45, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 362.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8030.0, "discounted_cash": 7032.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7425.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7425.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8030.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7425.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7425.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCT TST PLETHYSMOGRAP", "code_information": [{"code": "94726", "type": "CPT"}], "standard_charges": [{"minimum": 67.5, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 78.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 49.29, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5522.52, "maximum": 18376.27, "discounted_cash": 11046.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12128.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12128.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18376.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16100.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10607.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9055.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5522.52, "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": 6288.81, "maximum": 17586.16, "discounted_cash": 12281.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11607.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11607.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17586.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15407.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10151.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8665.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6288.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3635.11, "maximum": 11258.39, "discounted_cash": 7197.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7430.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7430.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11258.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9863.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6499.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5547.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3635.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TESTING", "code_information": [{"code": "94618", "type": "CPT"}], "standard_charges": [{"minimum": 18.65, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP CATH 10IN FENESTRATED GOPUMP", "code_information": [{"code": "AC-F100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 79.92, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"minimum": 160.87, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BREAST", "code_information": [{"code": "19000", "type": "CPT"}], "standard_charges": [{"minimum": 127.72, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BRST EA", "code_information": [{"code": "19001", "type": "CPT"}], "standard_charges": [{"minimum": 35.49, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"minimum": 125.73, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY 1 SQ CM", "code_information": [{"code": "Q4195", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 1 SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY XT 1 SQ CM", "code_information": [{"code": "Q4197", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURE TONE AUDIOMETRY AIR", "code_information": [{"code": "92552", "type": "CPT"}], "standard_charges": [{"minimum": 52.79, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 59.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZED BONE FIBER  10CC (DBF) 27500518", "code_information": [{"code": "27500518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2310.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DEMINERALIZED BONE FIBER  2.5CC 27512318", "code_information": [{"code": "27512318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.12, "setting": "both", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 105.7, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC CONT INFUSION", "code_information": [{"code": "64463", "type": "CPT"}], "standard_charges": [{"minimum": 351.99, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 351.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 201.2, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 201.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY COMPLICATED", "code_information": [{"code": "50135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1192.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1153.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1252.19, "methodology": "fee schedule"}], 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"maximum": 584.01, "discounted_cash": 15.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 11-20", "code_information": [{"code": "98971", "type": "CPT"}], "standard_charges": [{"minimum": 31.78, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 21+", "code_information": [{"code": "98972", "type": "CPT"}], "standard_charges": [{"minimum": 47.59, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 5-10", "code_information": [{"code": "98970", "type": "CPT"}], "standard_charges": [{"minimum": 17.12, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN PUPLMTRY PHY/QHP UNI/BI", "code_information": [{"code": "95919", "type": "CPT"}], "standard_charges": [{"minimum": 8.58, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUANTITATIVE ASSAY DRUG", "code_information": [{"code": "80299", "type": "CPT"}], "standard_charges": [{"minimum": 16.78, "maximum": 584.01, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7522", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANGIO", "code_information": [{"code": "93457", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1117.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1036.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1103.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93461", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1215.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH W/VENTRICLGRPHY", "code_information": [{"code": "93453", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1058.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"minimum": 109.2, "maximum": 4936.0, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 431.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 271.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC", "code_information": [{"code": "90375", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 342.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 289.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM", "code_information": [{"code": "90675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 383.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1844.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1612.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E <5CM", "code_information": [{"code": "24077", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1259.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1628.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR < 3 CM", "code_information": [{"code": "26117", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}], "standard_charges": [{"minimum": 24.6, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 90.59, "maximum": 584.01, "discounted_cash": 168.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 90.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 90.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 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schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 249.84, "maximum": 270.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 249.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 249.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 249.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 249.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 351.0, "maximum": 379.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 379.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.73, "maximum": 360.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 360.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.73, "maximum": 360.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 360.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 333.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6014", "type": "HCPCS"}], "standard_charges": [{"minimum": 334.18, "maximum": 361.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 334.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 334.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 361.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 334.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 334.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX DELIVERY IMRT", "code_information": [{"code": "G6015", "type": "HCPCS"}], "standard_charges": [{"minimum": 435.4, "maximum": 470.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 435.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 435.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 470.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 435.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 435.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 267.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1295.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF ELBOW", "code_information": [{"code": "24149", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1441.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION TUMOR SOFT TISSUE SHOULDER MORE THAN 5CM 23078", "code_information": [{"code": "23078", "type": "CPT"}, {"code": "1481685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1743.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOFREQUENCY GENERATOR PROCEDURE RENTAL RLVRFGPR", "code_information": [{"code": "RLVRFGPR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3211.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIOLOGY PORT IMAGES(S)", "code_information": [{"code": "77417", "type": "CPT"}], "standard_charges": [{"minimum": 16.75, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6029.41, "maximum": 12235.71, "discounted_cash": 24226.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8075.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8075.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12235.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10720.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7063.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6029.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11921.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY DOSE PLAN IMRT", "code_information": [{"code": "77301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2033.32, "discounted_cash": 1730.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1869.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1869.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2021.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1869.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1869.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2033.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95851", "type": "CPT"}], "standard_charges": [{"minimum": 33.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95852", "type": "CPT"}], "standard_charges": [{"minimum": 28.32, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAPID DESENSITIZATION", "code_information": [{"code": "95180", "type": "CPT"}], "standard_charges": [{"minimum": 187.94, "maximum": 584.01, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 276.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAR DO WHL GN&MTCDRL DNA ALS", "code_information": [{"code": "265U", "type": "CPT"}], "standard_charges": [{"minimum": 4928.22, "maximum": 4928.22, "discounted_cash": 7118.54, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4928.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4928.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DO ID OPT GEN MAPG&SEQ", "code_information": [{"code": "267U", "type": "CPT"}], "standard_charges": [{"minimum": 6065.4, "maximum": 6065.4, "discounted_cash": 8761.13, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6065.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6065.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS EA COMP", "code_information": [{"code": "213U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 2438.96, "discounted_cash": 3522.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2438.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2438.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS PROBAND", "code_information": [{"code": "212U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 4927.68, "discounted_cash": 7117.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4927.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4927.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "260U", "type": "CPT"}], "standard_charges": [{"minimum": 1137.18, "maximum": 1137.18, "discounted_cash": 1642.59, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "264U", "type": "CPT"}], "standard_charges": [{"minimum": 1137.18, "maximum": 1137.18, "discounted_cash": 1642.59, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ BLD/SLV", "code_information": [{"code": "336U", "type": "CPT"}], "standard_charges": [{"minimum": 2317.19, "maximum": 2317.19, "discounted_cash": 3347.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2317.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2317.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ FETA", "code_information": [{"code": "335U", "type": "CPT"}], "standard_charges": [{"minimum": 4702.14, "maximum": 4702.14, "discounted_cash": 6791.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4702.14, "methodology": "fee 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SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2317.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2317.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS PROBAND", "code_information": [{"code": "214U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 4702.14, "discounted_cash": 6791.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4702.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4702.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DEGLYCEROLIZED", "code_information": [{"code": "P9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 759.7, "maximum": 820.48, "discounted_cash": 383.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 759.7, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 10 BLD GROUPS", "code_information": [{"code": "84U", "type": "CPT"}], "standard_charges": [{"minimum": 648.0, "maximum": 1051.2, "discounted_cash": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 972.0, "methodology": "fee 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"maximum": 648.0, "discounted_cash": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNTYP 12 BLD GRP GEN", "code_information": [{"code": "282U", "type": "CPT"}], "standard_charges": [{"minimum": 648.0, "maximum": 648.0, "discounted_cash": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA HEA 35 AG 11 BLD GRP", "code_information": [{"code": "1U", "type": "CPT"}], "standard_charges": [{"minimum": 648.0, "maximum": 1051.2, "discounted_cash": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 972.0, "methodology": "fee 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"maximum": 473.77, "discounted_cash": 177.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 438.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 438.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 473.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 438.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC MECHANICAL FRAGILITY", "code_information": [{"code": "85547", "type": "CPT"}], "standard_charges": [{"minimum": 7.74, "maximum": 584.01, "discounted_cash": 11.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85555", "type": "CPT"}], "standard_charges": [{"minimum": 6.72, "maximum": 584.01, "discounted_cash": 9.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85557", "type": "CPT"}], "standard_charges": [{"minimum": 12.02, "maximum": 584.01, "discounted_cash": 17.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETREATMENT SERUM", "code_information": [{"code": "86978", "type": "CPT"}], "standard_charges": [{"minimum": 29.97, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/CHEMICL", "code_information": [{"code": "86970", "type": "CPT"}], "standard_charges": [{"minimum": 24.76, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}], "standard_charges": [{"minimum": 34.75, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/ENZYMES", "code_information": [{"code": "86971", "type": "CPT"}], "standard_charges": [{"minimum": 19.98, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX ID DILUTION", "code_information": [{"code": "86976", "type": "CPT"}], "standard_charges": [{"minimum": 20.69, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ DRUGS", "code_information": [{"code": "86975", "type": "CPT"}], "standard_charges": [{"minimum": 26.92, "maximum": 584.01, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 98.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 98.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ/INHIB", "code_information": [{"code": "86977", "type": "CPT"}], "standard_charges": [{"minimum": 29.97, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SICKLE CELL TEST", "code_information": [{"code": "85660", "type": "CPT"}], "standard_charges": [{"minimum": 4.96, "maximum": 584.01, "discounted_cash": 7.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC, FRZ/DEG/WSH, L/R, IRRAD", "code_information": [{"code": "P9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 869.16, "maximum": 938.69, "discounted_cash": 517.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 869.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 869.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 938.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 869.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC, L/R, CMV-NEG, IRRAD", "code_information": [{"code": "P9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 580.68, "maximum": 627.13, "discounted_cash": 305.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 218.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96932", "type": "CPT"}], "standard_charges": [{"minimum": 160.94, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 160.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96933", "type": "CPT"}], "standard_charges": [{"minimum": 58.04, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 58.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96934", "type": "CPT"}], "standard_charges": [{"minimum": 154.19, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96935", "type": "CPT"}], "standard_charges": [{"minimum": 99.82, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee 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for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1112.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1579.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REACTIV8 RELEASE TOOL EXT1A", "code_information": [{"code": "EXT1A", "type": "CDM"}], "standard_charges": [{"gross_charge": 5050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "READYBATH TOTAL BODY CLEANSING STANDARD WEIGHT WASHCLOTHS MSC095307", "code_information": [{"code": "MSC095307", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.74, "setting": "both", "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1154.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1177.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1161.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF LOWER LEG", "code_information": [{"code": "27712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1341.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF TENDONS", "code_information": [{"code": "26437", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 857.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1559.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REAMER BLADE WITH PILOT HOLE  SIZE 41 PATELLA 00597909541", "code_information": [{"code": "597909541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CUTTING INST STAGE 1 HIP HAR-000-S154-000101", "code_information": [{"code": "HAR-000-S154-000101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CUTTING INST STAGE 2-54MM HIP HAR-000-S254", "code_information": [{"code": "HAR-000-S254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA 35MM", "code_information": [{"code": "5979-95-35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA 38MM", "code_information": [{"code": "5979-95-38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PATELLA W/ PILOT HOLE 46MM", "code_information": [{"code": "5979-95-46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 41MM PATELLA", "code_information": [{"code": "5979-95-41", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 51MM PATELLA", "code_information": [{"code": "5979-95-51", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REBOUND MATRIX, PER SQ CM", "code_information": [{"code": "Q4296", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1291.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69633", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1255.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69636", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1716.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69637", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1710.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1377.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1900.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1338.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1323.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1455.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1509.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1438.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 525.71, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 525.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1919.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1079.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1660.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1626.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1527.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1218.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1807.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1928.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 967.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1157.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.41, "maximum": 59.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/FIXATION", "code_information": [{"code": "21196", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1735.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1715.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1629.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O GRAFT", "code_information": [{"code": "21193", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1485.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1222.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1216.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 33925.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1174.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1730.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1351.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1117.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1151.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 714.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1281.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2456.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2666.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2863.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1105.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1227.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW LAT LIGMNT", "code_information": [{"code": "24344", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1359.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW MED LIGMNT", "code_information": [{"code": "24346", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1359.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1783.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1986.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1281.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 934.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1012.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 798.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24366", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 840.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1720.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3423.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 664.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 741.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1901.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1632.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2650.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2566.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 21687.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1438.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21687.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17827.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23472", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 21687.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1720.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21687.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17827.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ULNA/RADIOULNAR", "code_information": [{"code": "25337", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT UPPER JAW BONE", "code_information": [{"code": "21206", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1179.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 1", "code_information": [{"code": "53420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1023.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 2", "code_information": [{"code": "53425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1393.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1861.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1384.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1648.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25441", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1146.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 981.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25443", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 972.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25444", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1005.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 879.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1350.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27427", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 876.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27428", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1372.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27429", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1546.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1916.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 943.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 926.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1039.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67971", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 824.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67973", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1055.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67974", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1053.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67975", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 783.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1561.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1334.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1708.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21246", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1028.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21248", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1369.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21249", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1879.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1235.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21243", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 33925.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1954.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1199.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1912.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1113.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1709.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2143.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1969.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 392.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1579.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1790.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1748.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1479.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1140.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1294.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 975.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1188.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1367.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1175.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 876.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1000.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1206.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 873.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1175.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1145.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2183.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TONGUE FOLD", "code_information": [{"code": "41520", "type": "CPT"}], "standard_charges": [{"minimum": 478.21, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 478.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECOTHROM 20,000 UNIT SPRAY KIT", "code_information": [{"code": "MED0410", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 806.85, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOTHROM 5,000 UNITS/5ML", "code_information": [{"code": "MED0411", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 234.29, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOTHROM THROMBIN TOPICAL SPRAY 20,000 IU", "code_information": [{"code": "MED0202", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 836.03, "setting": "both", "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9485.21, "maximum": 27318.02, "discounted_cash": 20942.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18030.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18030.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27318.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23934.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15769.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13461.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9485.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15480.81, "maximum": 40983.91, "discounted_cash": 32373.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27049.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27049.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40983.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35907.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23658.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20195.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15480.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7402.33, "maximum": 18767.2, "discounted_cash": 14645.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12386.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12386.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18767.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16442.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10833.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9247.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7402.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 630.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 630.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 680.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 630.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECTANGULAR PLASTIC WASHBASINS DYND80342", "code_information": [{"code": "DYND80342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5346.36, "maximum": 10849.57, "discounted_cash": 12556.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7160.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7160.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10849.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9505.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6263.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5346.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6278.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3712.34, "maximum": 7533.58, "discounted_cash": 8209.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4972.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4972.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7533.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6600.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4348.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3712.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4118.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS, LEUKOCYTES REDUCED; EACH UNIT P9016", "code_information": [{"code": "P9016", "type": "HCPCS"}, {"code": "45850904", "type": "CDM"}, {"code": "381", "type": "RC"}], "standard_charges": [{"minimum": 381.42, "maximum": 411.93, "gross_charge": 289.51, "discounted_cash": 226.29, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 411.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 381.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 104.13, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 112.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 82.47, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 111.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 112.68, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 139.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 129.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 134.21, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 185.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4131.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1567.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1152.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCE TESTIS TORSION", "code_information": [{"code": "54600", "type": "CPT"}], "standard_charges": [{"minimum": 562.28, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 562.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCER 5584134 CDHS 5.5/6.0 BEALE SLOTS 5584134", "code_information": [{"code": "5584134", "type": "CDM"}], "standard_charges": [{"gross_charge": 21411.19, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCTION OF FACIAL BONES", "code_information": [{"code": "21209", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1068.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 908.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1305.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF RECTAL PROLAPSE", "code_information": [{"code": "45900", "type": "CPT"}], "standard_charges": [{"minimum": 275.52, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 275.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2133.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2409.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"minimum": 450.97, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PORTABLE PUMP", "code_information": [{"code": "96521", "type": "CPT"}], "standard_charges": [{"minimum": 187.92, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 242.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 242.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 262.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 242.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 187.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PUMP/RESVR SYST", "code_information": [{"code": "96522", "type": "CPT"}], "standard_charges": [{"minimum": 163.84, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 199.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 199.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 215.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 199.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGUARD, TOPICAL USE PER SQ", "code_information": [{"code": "Q4255", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6812.77, "maximum": 25937.39, "discounted_cash": 13846.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17118.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17118.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25937.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22724.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14972.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12781.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6812.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4982.94, "maximum": 17593.05, "discounted_cash": 10253.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11611.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11611.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17593.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15413.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10155.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8669.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4982.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 172.69, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1350.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1301.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1363.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1463.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2581.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1056.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE EYE WALL", "code_information": [{"code": "67250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1070.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1213.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE HUMERUS", "code_information": [{"code": "24498", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1058.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1512.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 895.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1112.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1236.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1366.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE TIBIA", "code_information": [{"code": "27745", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 916.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE/GRAFT EYE WALL", "code_information": [{"code": "67255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 806.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1170.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1150.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "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": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1586.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 584.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1411.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2179.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2288.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FINGER CONTRACTURE", "code_information": [{"code": "26525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 892.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FOOT/TOE NERVE", "code_information": [{"code": "64726", "type": "CPT"}], "standard_charges": [{"minimum": 348.96, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 348.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE FOREARM/HAND TENDON", "code_information": [{"code": "26449", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 874.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE HAND/FINGER TENDON", "code_information": [{"code": "26445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 797.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2191.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE KNUCKLE CONTRACTURE", "code_information": [{"code": "26520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 957.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE MUSCLES OF HAND", "code_information": [{"code": "26593", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF BIG TOE", "code_information": [{"code": "28240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 588.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EYE FLUID", "code_information": [{"code": "67015", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT CONTRACTURE", "code_information": [{"code": "28270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 597.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28225", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28222", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28226", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 874.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDON", "code_information": [{"code": "27680", "type": "CPT"}], "standard_charges": [{"minimum": 543.36, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDONS", "code_information": [{"code": "27681", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 650.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2014.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6090.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1272.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 869.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1548.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1875.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF TOE JOINT EACH", "code_information": [{"code": "28272", "type": "CPT"}], "standard_charges": [{"minimum": 505.2, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 505.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1479.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1207.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1081.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM & FINGER TENDON", "code_information": [{"code": "26442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1268.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26040", "type": "CPT"}], "standard_charges": [{"minimum": 408.2, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 408.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 598.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 744.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26123", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1034.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26125", "type": "CPT"}], "standard_charges": [{"minimum": 303.3, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 303.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM/FINGER TENDON", "code_information": [{"code": "26440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 847.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE SHOULDER JOINT", "code_information": [{"code": "23020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE THUMB CONTRACTURE", "code_information": [{"code": "26508", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE WRIST/FOREARM TENDON", "code_information": [{"code": "25295", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 657.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1333.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELESE, PER SQ CM", "code_information": [{"code": "Q4257", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONTRACTURE", "code_information": [{"code": "52640", "type": "CPT"}], "standard_charges": [{"minimum": 406.11, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 406.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2517.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "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": 819.35, "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": 157.82, "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, "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": 189.03, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 478.33, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 478.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 407.39, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 407.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1863.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 47.54, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 102.96, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS PHYS", "code_information": [{"code": "578T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS TECH", "code_information": [{"code": "579T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 41.41, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 49.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 41.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"minimum": 40.39, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"minimum": 61.99, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"minimum": 28.1, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR SETUP", "code_information": [{"code": "607T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"minimum": 71.26, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 71.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA DEV SETUP&EDUCAJ", "code_information": [{"code": "604T", "type": "CPT"}], "standard_charges": [{"minimum": 160.3, "maximum": 173.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA TECHL SPRT MIN 8", "code_information": [{"code": "605T", "type": "CPT"}], "standard_charges": [{"minimum": 50.15, "maximum": 993.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 50.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 50.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 50.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 50.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 993.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR 1ST 20 MIN", "code_information": [{"code": "99457", "type": "CPT"}], "standard_charges": [{"minimum": 69.82, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR EA ADDL 20", "code_information": [{"code": "99458", "type": "CPT"}], "standard_charges": [{"minimum": 56.25, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST 20 MIN", "code_information": [{"code": "98980", "type": "CPT"}], "standard_charges": [{"minimum": 73.11, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST SETUP&EDU", "code_information": [{"code": "98975", "type": "CPT"}], "standard_charges": [{"minimum": 28.1, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY CBT", "code_information": [{"code": "98978", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY RESP", "code_information": [{"code": "98976", "type": "CPT"}], "standard_charges": [{"minimum": 61.99, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DV SPLY MSCSKL", "code_information": [{"code": "98977", "type": "CPT"}], "standard_charges": [{"minimum": 52.36, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR EA ADDL 20 MIN", "code_information": [{"code": "98981", "type": "CPT"}], "standard_charges": [{"minimum": 56.43, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOT IMAGE SUBMIT BY PT", "code_information": [{"code": "G2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.68, "maximum": 17.68, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOT IMG SUB BY PT, NON E/M", "code_information": [{"code": "G2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.68, "maximum": 17.68, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93228", "type": "CPT"}], "standard_charges": [{"minimum": 34.36, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93270", "type": "CPT"}], "standard_charges": [{"minimum": 10.77, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG TECH SUPP", "code_information": [{"code": "93229", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1297.68, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1201.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1201.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1297.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1201.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 993.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT  15MINS", "code_information": [{"code": "G9984", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.97, "maximum": 112.97, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 112.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9486", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.67, "maximum": 24.67, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9983", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.33, "maximum": 69.33, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 15MINS", "code_information": [{"code": "G9487", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.04, "maximum": 49.04, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9488", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.86, "maximum": 75.86, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9985", "type": "HCPCS"}], "standard_charges": [{"minimum": 163.44, "maximum": 163.44, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9489", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.05, "maximum": 107.05, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9986", "type": "HCPCS"}], "standard_charges": [{"minimum": 227.46, "maximum": 227.46, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9481", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.67, "maximum": 24.67, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9978", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.33, "maximum": 69.33, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.61, "maximum": 46.61, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9979", "type": "HCPCS"}], "standard_charges": [{"minimum": 101.33, "maximum": 101.33, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30 MINS", "code_information": [{"code": "G9980", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.59, "maximum": 149.59, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30MINS", "code_information": [{"code": "G9483", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.53, "maximum": 72.53, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 72.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9484", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.25, "maximum": 123.25, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9981", "type": "HCPCS"}], "standard_charges": [{"minimum": 231.38, "maximum": 231.38, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9485", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.99, "maximum": 161.99, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9982", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.41, "maximum": 303.41, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 303.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY LMBR/SAC", "code_information": [{"code": "63307", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2939.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3008.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2830.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2910.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1254.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1545.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 873.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1626.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ANTERIOR INSTRUMENTATION SPINE 22855", "code_information": [{"code": "22855", "type": "CPT"}, {"code": "1481782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1357.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL BENIGN TUMOR OF FACIAL BONE BY CONTOURING 21029", "code_information": [{"code": "21029", "type": "CPT"}, {"code": "1481764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 4145.32, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1078.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 611.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 420.89, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 420.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40804", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 388.76, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 388.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY UPPER ARM/ELBOW-SUBCUTANEOUS 24200", "code_information": [{"code": "24200", "type": "CPT"}, {"code": "1481769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 319.99, "maximum": 4936.0, "gross_charge": 1151.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 460.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 690.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 748.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 319.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT-DEEP 20680", "code_information": [{"code": "20680", "type": "CPT"}, {"code": "1481786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 3631.77, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT-SUPERFICIAL 20670", "code_information": [{"code": "20670", "type": "CPT"}, {"code": "1481787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2065.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 488.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1432.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1540.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 676.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1282.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42830", "type": "CPT"}], "standard_charges": [{"minimum": 260.61, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42831", "type": "CPT"}], "standard_charges": [{"minimum": 284.16, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 284.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42835", "type": "CPT"}], "standard_charges": [{"minimum": 244.26, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42836", "type": "CPT"}], "standard_charges": [{"minimum": 298.15, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL FISSURE", "code_information": [{"code": "46200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 700.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL TAGS", "code_information": [{"code": "46230", "type": "CPT"}], "standard_charges": [{"minimum": 451.33, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 451.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE BONE", "code_information": [{"code": "28130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 704.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE/HEEL LESION", "code_information": [{"code": "28100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 854.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANORECTAL LESION", "code_information": [{"code": "45108", "type": "CPT"}], "standard_charges": [{"minimum": 487.08, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 711.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1090.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 710.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1651.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1211.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1764.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2178.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2529.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 783.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 734.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1043.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 940.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 584.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 701.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23146", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 785.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2352.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2684.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2738.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61516", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2307.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3396.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4450.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3809.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2564.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3922.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3702.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2065.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3133.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2973.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3212.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2883.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2672.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2668.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2746.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST LESION", "code_information": [{"code": "19120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST TISSUE", "code_information": [{"code": "19300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 836.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BROW WRINKLES", "code_information": [{"code": "15826", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CALCIUM DEPOSITS", "code_information": [{"code": "23000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 756.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX", "code_information": [{"code": "57530", "type": "CPT"}], "standard_charges": [{"minimum": 450.51, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2101.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1163.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 704.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1121.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLLAR BONE", "code_information": [{"code": "23125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2275.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1518.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2621.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2531.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2799.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54860", "type": "CPT"}], "standard_charges": [{"minimum": 522.68, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 522.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54861", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 701.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 991.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3608.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5362.61, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5362.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5272.6, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5272.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4649.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 950.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1816.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 945.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1131.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 480.33, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 480.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1019.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1547.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65400", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 897.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FALLOPIAN TUBE", "code_information": [{"code": "58700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 968.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 864.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER LESION", "code_information": [{"code": "26210", "type": "CPT"}], "standard_charges": [{"minimum": 566.55, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 566.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER TENDON", "code_information": [{"code": "26180", "type": "CPT"}], "standard_charges": [{"minimum": 570.18, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 570.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FASCIA", "code_information": [{"code": "28062", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 786.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28190", "type": "CPT"}], "standard_charges": [{"minimum": 318.74, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 318.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28192", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 611.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28193", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28070", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 691.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28072", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 669.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28080", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28090", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 626.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28104", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREARM LESION", "code_information": [{"code": "25120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 628.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREHEAD WRINKLES", "code_information": [{"code": "15824", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20520", "type": "CPT"}], "standard_charges": [{"minimum": 304.48, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 655.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "27372", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1310.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1399.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1445.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1487.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1409.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1336.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1321.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1386.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1532.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1553.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1672.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 665.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4028.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2556.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1719.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3216.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL BONE", "code_information": [{"code": "28118", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 839.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL SPUR", "code_information": [{"code": "28119", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEMORRHOID CLOT", "code_information": [{"code": "46320", "type": "CPT"}], "standard_charges": [{"minimum": 307.15, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1897.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 987.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 847.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55040", "type": "CPT"}], "standard_charges": [{"minimum": 423.41, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 423.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55500", "type": "CPT"}], "standard_charges": [{"minimum": 491.92, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 491.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELES", "code_information": [{"code": "55041", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 634.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED WAX MD", "code_information": [{"code": "G0268", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.27, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT FROM HAND", "code_information": [{"code": "26320", "type": "CPT"}], "standard_charges": [{"minimum": 446.18, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"minimum": 413.28, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE FLUID", "code_information": [{"code": "67036", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1029.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 717.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30117", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1254.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30118", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 847.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1255.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66625", "type": "CPT"}], "standard_charges": [{"minimum": 501.28, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 664.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 593.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW BONE LESION", "code_information": [{"code": "21044", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1024.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW JOINT", "code_information": [{"code": "21050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1063.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1223.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1768.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1094.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 810.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 743.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CYST", "code_information": [{"code": "27345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE PROSTHESIS", "code_information": [{"code": "27488", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1451.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP", "code_information": [{"code": "27350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 818.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP BURSA", "code_information": [{"code": "27340", "type": "CPT"}], "standard_charges": [{"minimum": 487.34, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2417.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2969.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3259.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1498.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 287.79, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 287.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1126.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 698.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS LESION", "code_information": [{"code": "66830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 818.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 800.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 909.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 963.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4310.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2138.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1249.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1277.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 950.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1592.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38724", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1690.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL", "code_information": [{"code": "28140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL HEADS", "code_information": [{"code": "28114", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "11750", "type": "CPT"}], "standard_charges": [{"minimum": 210.89, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 210.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL PLATE", "code_information": [{"code": "11730", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 149.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NECK WRINKLES", "code_information": [{"code": "15825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1541.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE", "code_information": [{"code": "30160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 971.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30124", "type": "CPT"}], "standard_charges": [{"minimum": 372.06, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 372.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 787.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 326.61, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 326.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30115", "type": "CPT"}], "standard_charges": [{"minimum": 576.15, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT", "code_information": [{"code": "65175", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 938.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OMENTUM", "code_information": [{"code": "49255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 987.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARIAN CYST(S)", "code_information": [{"code": "58925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 924.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 680.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1485.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY/TUBE(S)", "code_information": [{"code": "58720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 923.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 563.53, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PALM TENDON EACH", "code_information": [{"code": "26170", "type": "CPT"}], "standard_charges": [{"minimum": 518.24, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2238.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1365.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1536.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1452.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2754.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3544.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PENIS", "code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2822.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1903.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 278.95, "maximum": 4936.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 278.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PREVIOUSLY IMPLANTED INTRATEHCAL OR EPIDURAL CATHETER 62355", "code_information": [{"code": "62355", "type": "CPT"}, {"code": "1863137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 367.96, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1329.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1046.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 374.16, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 374.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2224.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2208.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1953.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2124.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 933.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57550", "type": "CPT"}], "standard_charges": [{"minimum": 513.67, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 513.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 762.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 871.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1690.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42330", "type": "CPT"}], "standard_charges": [{"minimum": 315.45, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42335", "type": "CPT"}], "standard_charges": [{"minimum": 567.66, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 567.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 697.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM", "code_information": [{"code": "55150", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM LESION", "code_information": [{"code": "55120", "type": "CPT"}], "standard_charges": [{"minimum": 446.04, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SESAMOID BONE", "code_information": [{"code": "28315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 566.61, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 566.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN WRINKLES", "code_information": [{"code": "15829", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1487.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 283.51, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1439.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM CORD LESION", "code_information": [{"code": "55520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 588.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM DUCT(S)", "code_information": [{"code": "55250", "type": "CPT"}], "standard_charges": [{"minimum": 461.79, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 461.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL NEUROSTIMULATOR ELEC. PLATE/PADDLES VIA LAMINOTOMY/LAMINECTOMY INC. FLUORO. 63662", "code_information": [{"code": "63662", "type": "CPT"}, {"code": "2580939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 10180.0, "gross_charge": 3437.0, "discounted_cash": 4371.19, "estimated_discounted_cash": 15790.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1091.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAYS-INC. FLUOROSCOPY 63661", "code_information": [{"code": "63661", "type": "CPT"}, {"code": "1481811", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 10180.0, "gross_charge": 3437.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 979.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1416.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1405.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 309.76, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 309.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2390.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2735.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2774.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1771.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2452.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2322.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2556.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 131.54, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.54, "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": 387.13, "maximum": 6923.0, "gross_charge": 1690.0, "discounted_cash": 4271.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 387.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURE FROM ANUS", "code_information": [{"code": "46754", "type": "CPT"}], "standard_charges": [{"minimum": 505.29, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 505.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL)-OTHER SURGEON 15851", "code_information": [{"code": "15851", "type": "CPT"}, {"code": "1481819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 78.98, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2579.72, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 78.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE", "code_information": [{"code": "27080", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 655.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", "code_information": [{"code": "68500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 868.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON LESION", "code_information": [{"code": "27630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 752.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54520", "type": "CPT"}], "standard_charges": [{"minimum": 410.18, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 410.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1288.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1415.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1703.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1097.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1562.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1625.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60271", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1253.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE", "code_information": [{"code": "28150", "type": "CPT"}], "standard_charges": [{"minimum": 553.68, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 553.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28092", "type": "CPT"}], "standard_charges": [{"minimum": 563.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28108", "type": "CPT"}], "standard_charges": [{"minimum": 576.05, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2576.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42825", "type": "CPT"}], "standard_charges": [{"minimum": 325.56, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 325.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42826", "type": "CPT"}], "standard_charges": [{"minimum": 309.53, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 309.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOTAL DISC ARTHROPLASTY ANT. APPROACH EA. ADD. INTERSPACE CERVICAL 0095T", "code_information": [{"code": "95T", "type": "CPT"}, {"code": "45487764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOTAL DISC ARTHROPLASTY; ANTERIOR; SINGLE; CERVICAL 22864", "code_information": [{"code": "22864", "type": "CPT"}, {"code": "44717147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2557.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2114.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2339.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1256.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1381.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1144.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1083.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 940.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1125.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 494.78, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 494.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53270", "type": "CPT"}], "standard_charges": [{"minimum": 293.45, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 745.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1592.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1706.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1285.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 689.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONE", "code_information": [{"code": "25210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 618.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONES", "code_information": [{"code": "25215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 765.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST LESION", "code_information": [{"code": "25130", "type": "CPT"}], "standard_charges": [{"minimum": 570.31, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 570.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 893.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 746.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 10219.2, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION SPINE 22850", "code_information": [{"code": "22850", "type": "CPT"}, {"code": "1481783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION SPINE 22852", "code_information": [{"code": "22852", "type": "CPT"}, {"code": "1481784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 896.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PROSTH RADIAL HEAD", "code_information": [{"code": "24164", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 899.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR&STAPL XREQ ANES", "code_information": [{"code": "15854", "type": "CPT"}], "standard_charges": [{"minimum": 23.03, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPL XREQ ANES", "code_information": [{"code": "15853", "type": "CPT"}], "standard_charges": [{"minimum": 17.77, "maximum": 1100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36589", "type": "CPT"}], "standard_charges": [{"minimum": 221.49, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36590", "type": "CPT"}], "standard_charges": [{"minimum": 298.83, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 298.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL UNDER ANESTHESIA OF EXTERNAL FIXATION SYSTEM 20694", "code_information": [{"code": "20694", "type": "CPT"}, {"code": "1481768", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.0, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 2010.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 609.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 91.47, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 114.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 114.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 123.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 114.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 91.99, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 124.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 124.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 134.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 124.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 91.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 215.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 215.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 232.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 215.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2335.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1294.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 313.45, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 313.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 832.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST COMPLEX", "code_information": [{"code": "46280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 639.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST INTER", "code_information": [{"code": "46275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 832.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST SUBQ", "code_information": [{"code": "46270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 790.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4066.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 730.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 754.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1551.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1672.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1590.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 39.18, "maximum": 10032.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 880.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38745", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1099.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52317", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1152.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}], "standard_charges": [{"minimum": 561.33, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 561.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2824.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2277.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2314.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2617.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 742.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 94.57, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 126.46, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY SHUNT", "code_information": [{"code": "62256", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 817.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1303.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3115.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3567.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2608.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1611.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1959.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20912", "type": "CPT"}], "standard_charges": [{"minimum": 580.52, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 580.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 155.35, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 696.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 982.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 732.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 864.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2345.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CONTRACEPTIVE CAPSULE", "code_information": [{"code": "11976", "type": "CPT"}], "standard_charges": [{"minimum": 194.45, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 194.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 141.07, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 134.39, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 187.43, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 202.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 187.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 269.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 68.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 73.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DIGIT NERVE LESION", "code_information": [{"code": "64776", "type": "CPT"}], "standard_charges": [{"minimum": 498.41, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 498.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 265.82, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 265.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT DEVICE", "code_information": [{"code": "11982", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1118.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69145", "type": "CPT"}], "standard_charges": [{"minimum": 535.6, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 277.95, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1302.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69552", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1907.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2991.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1021.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1089.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1229.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1707.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54830", "type": "CPT"}], "standard_charges": [{"minimum": 467.91, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 467.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54840", "type": "CPT"}], "standard_charges": [{"minimum": 402.1, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 402.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 129.75, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 140.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 517.33, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 517.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MAXILLA", "code_information": [{"code": "21032", "type": "CPT"}], "standard_charges": [{"minimum": 510.06, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXT HEM GROUPS 2+", "code_information": [{"code": "46250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 706.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTERNAL EAR PARTIAL", "code_information": [{"code": "69110", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 621.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 899.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1037.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "66130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 948.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/ATTACH IMPLANT", "code_information": [{"code": "65105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1139.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1049.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1766.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65114", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1838.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 335.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67800", "type": "CPT"}], "standard_charges": [{"minimum": 175.22, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67840", "type": "CPT"}], "standard_charges": [{"minimum": 370.16, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 370.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION(S)", "code_information": [{"code": "67808", "type": "CPT"}], "standard_charges": [{"minimum": 431.61, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 431.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "type": "CPT"}], "standard_charges": [{"minimum": 221.75, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 221.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67805", "type": "CPT"}], "standard_charges": [{"minimum": 277.02, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68110", "type": "CPT"}], "standard_charges": [{"minimum": 316.53, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 441.21, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 441.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 741.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 214.66, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 214.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION", "code_information": [{"code": "27355", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 761.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/BURSA", "code_information": [{"code": "27062", "type": "CPT"}], "standard_charges": [{"minimum": 571.93, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 571.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 312.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 312.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27356", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 721.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 662.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM FOREIGN BODY", "code_information": [{"code": "25248", "type": "CPT"}], "standard_charges": [{"minimum": 537.64, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 537.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1048.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2320.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65205", "type": "CPT"}], "standard_charges": [{"minimum": 38.52, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 51.96, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], "standard_charges": [{"minimum": 85.47, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 90.44, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65265", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1276.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 280.14, "maximum": 4936.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 438.21, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 438.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1028.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1613.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HAND BONE LESION", "code_information": [{"code": "26200", "type": "CPT"}], "standard_charges": [{"minimum": 567.38, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 567.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1001.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES SUPER", "code_information": [{"code": "27065", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 446.28, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 446.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 784.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1148.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1128.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1229.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1929.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 955.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23184", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69209", "type": "CPT"}], "standard_charges": [{"minimum": 22.15, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69210", "type": "CPT"}], "standard_charges": [{"minimum": 63.94, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 63.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GROUPS 2+", "code_information": [{"code": "46260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 633.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP & FISS", "code_information": [{"code": "46257", "type": "CPT"}], "standard_charges": [{"minimum": 555.2, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP W/FISTU", "code_information": [{"code": "46258", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 627.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS & FISS", "code_information": [{"code": "46261", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 682.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS W/FIST", "code_information": [{"code": "46262", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1369.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1092.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1169.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2470.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INT/EXT HEM 1 GROUP", "code_information": [{"code": "46255", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 766.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1144.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2143.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRAUTERINE DEVICE", "code_information": [{"code": "58301", "type": "CPT"}], "standard_charges": [{"minimum": 147.91, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1946.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IRIS AND LESION", "code_information": [{"code": "66600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1066.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 959.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1935.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE CYST", "code_information": [{"code": "27347", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 857.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 948.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LIMB NERVE LESION", "code_information": [{"code": "64782", "type": "CPT"}], "standard_charges": [{"minimum": 582.11, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 582.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LOWER LEG BONE LESION", "code_information": [{"code": "27635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3221.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1710.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1949.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1208.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1121.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1502.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1220.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 896.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "11732", "type": "CPT"}], "standard_charges": [{"minimum": 43.55, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30300", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 281.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30310", "type": "CPT"}], "standard_charges": [{"minimum": 253.13, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NERVE LESION", "code_information": [{"code": "64784", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PALATE/LESION", "code_information": [{"code": "42120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1216.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1492.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3162.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1492.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 987.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1444.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1819.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 283.99, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 283.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST COMPL", "code_information": [{"code": "11772", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1112.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST EXTEN", "code_information": [{"code": "11771", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 908.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST SIMPLE", "code_information": [{"code": "11770", "type": "CPT"}], "standard_charges": [{"minimum": 512.23, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 512.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1816.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 506.55, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 506.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 338.48, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 259.62, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 259.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 531.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2296.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 522.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1081.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1178.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1386.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1101.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1221.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1240.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 659.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 719.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23182", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 845.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BONE PART", "code_information": [{"code": "23130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 606.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FOREIGN BODY", "code_information": [{"code": "23330", "type": "CPT"}], "standard_charges": [{"minimum": 431.32, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 431.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 798.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64774", "type": "CPT"}], "standard_charges": [{"minimum": 543.3, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 879.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 433.74, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1375.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 993.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1522.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1389.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 948.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1145.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1424.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TENDON SHEATH LESION", "code_information": [{"code": "26160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1092.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1104.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1217.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1439.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1434.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"minimum": 255.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60280", "type": "CPT"}], "standard_charges": [{"minimum": 546.88, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60281", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 703.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID LESION", "code_information": [{"code": "60200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 821.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42820", "type": "CPT"}], "standard_charges": [{"minimum": 349.37, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 349.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42821", "type": "CPT"}], "standard_charges": [{"minimum": 364.51, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 364.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1531.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TUNNELED IP CATH", "code_information": [{"code": "49422", "type": "CPT"}], "standard_charges": [{"minimum": 264.33, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 264.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 714.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1085.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URO SPHINCTER", "code_information": [{"code": "53446", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6923.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 547.02, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 547.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 992.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA GLAND LESION", "code_information": [{"code": "56740", "type": "CPT"}], "standard_charges": [{"minimum": 376.1, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 376.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57130", "type": "CPT"}], "standard_charges": [{"minimum": 294.14, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 294.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57135", "type": "CPT"}], "standard_charges": [{"minimum": 322.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 322.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2136.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1752.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1066.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "type": "CPT"}], "standard_charges": [{"minimum": 208.2, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 208.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 975.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8823.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 620.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 411.39, "maximum": 4936.0, "discounted_cash": 4661.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILATING TUBE", "code_information": [{"code": "69424", "type": "CPT"}], "standard_charges": [{"minimum": 172.77, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1357.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1623.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63090", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2364.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2788.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2833.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2885.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3059.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2720.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2689.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 219.34, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 219.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 299.99, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 299.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 204.78, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 204.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 336.66, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 336.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 368.32, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 422.82, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 422.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1235.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1780.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT CARTILAGE", "code_information": [{"code": "25107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT IMPLANT", "code_information": [{"code": "25449", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1235.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "25105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 613.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "26130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 604.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25110", "type": "CPT"}], "standard_charges": [{"minimum": 445.92, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 445.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 931.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 396.98, "maximum": 8117.0, "discounted_cash": 10346.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 396.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT BONE LESION", "code_information": [{"code": "26205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 759.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FINGER LESION", "code_information": [{"code": "26215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 716.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28102", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 768.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28103", "type": "CPT"}], "standard_charges": [{"minimum": 492.79, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 492.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28106", "type": "CPT"}], "standard_charges": [{"minimum": 540.79, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 540.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 668.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 752.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 757.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1263.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27637", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 935.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27638", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 928.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPAIR HEARING AID", "code_information": [{"code": "69711", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1055.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 987.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REVISE MALE SLING", "code_information": [{"code": "53442", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 966.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 925.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1877.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 413.94, "maximum": 8117.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 433.05, "maximum": 8117.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 433.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 883.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 25913.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 8164.17, "discounted_cash": 5201.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8164.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1237.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL BIOPSY PERQ", "code_information": [{"code": "50200", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 651.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 933.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3967.16, "maximum": 11446.97, "discounted_cash": 7830.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7555.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7555.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11446.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10029.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6607.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5640.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3967.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6702.98, "maximum": 18917.24, "discounted_cash": 13242.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12485.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12485.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18917.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16574.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10920.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9321.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6702.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2710.83, "maximum": 7956.17, "discounted_cash": 5367.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5251.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5251.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7956.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6970.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4592.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3920.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2710.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 694.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 188.39, "maximum": 584.01, "discounted_cash": 272.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 243.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 243.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 262.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 243.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 243.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 39.59, "maximum": 584.01, "discounted_cash": 57.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "type": "CPT"}], "standard_charges": [{"minimum": 340.05, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 340.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58350", "type": "CPT"}], "standard_charges": [{"minimum": 189.1, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 189.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1275.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"minimum": 178.25, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 178.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"minimum": 186.85, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP 3.5MM STERLING CUDA MICROBLADE", "code_information": [{"code": "C9952R", "type": "CDM"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND 90DEG RHT ANGL", "code_information": [{"code": "AC 1340-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 314.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND ELIMINATOR 90 4.5MM RT ANGL", "code_information": [{"code": "AC 1345-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 314.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ARTHROWAND MULTIVAC 50 3.75MM XL SUCTION GREY/WHITE", "code_information": [{"code": "ASC 4730-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 341.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 1.5MM WIRE PASS", "code_information": [{"code": "1608-2-59R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.12, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 1.5MM X 85MM 2 FLUTE QUICK COUPLINGINSTR", "code_information": [{"code": "310.15R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.34, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2.5MM EMERGE", "code_information": [{"code": "310.25EMR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 2MM X 100MM QUICK COUPLING SSINSTR", "code_information": [{"code": "310.19R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL 4.5MM CANNULATED ENDO KNEE STRLINSTR DISP", "code_information": [{"code": "7207315R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 339.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRILL QC GOLD 25X110MM", "code_information": [{"code": "310.25R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.34, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BIT DRLL 1.8MM X 110MM MINI QUICK COUPLING NON STRL W/ DEPTH MARKINSTR", "code_information": [{"code": "310.509R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.34, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ENDO CTR SCOPE MOUNTING", "code_information": [{"code": "9900-BR", "type": "CDM"}], "standard_charges": [{"gross_charge": 601.31, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ENDO CTR SLIMLINE PROW TIP", "code_information": [{"code": "82020R", "type": "CDM"}], "standard_charges": [{"gross_charge": 447.63, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 2.9 X 110M STRT TRICUT INF TURB M4 ROT STRAIGHT", "code_information": [{"code": "18-82940H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.44, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 4MM X 11CM TRICUT STRAIGHT", "code_information": [{"code": "18-84004H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 281.87, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE ETHMOIDECTOMY 4MM X 11CM TRICUT STRAIGHT OFFSET", "code_information": [{"code": "18-84004R", "type": "CDM"}], "standard_charges": [{"gross_charge": 272.7, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE GATOR LARGE 8.2CM", "code_information": [{"code": "C9961AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE INF TURB 2MM M4 ROT", "code_information": [{"code": "18-82040H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.61, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE INFERIOR TURBINATE 2.9MM X 11CM", "code_information": [{"code": "18-82940R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILATING 5.5MM X 18MM .38MM", "code_information": [{"code": "2296-3-412R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILLATING 19.5 X 19.5 X 90 X 1.19MM STAND", "code_information": [{"code": "5071-303R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE OSCILLATING19 X 95 X 1.37MM", "code_information": [{"code": "5071-530R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE RECIPROCATING 77.5MM HVY DTY", "code_information": [{"code": "277-96-325R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.26, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAGGITAL 9 X 24MM OSCILLLATING AGGRESSIVE THIN", "code_information": [{"code": "SP-511R", "type": "CDM"}], "standard_charges": [{"gross_charge": 44.32, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAGITTAL FLARE 48.5MM X 64NN X 12.5MM", "code_information": [{"code": "2108-197R", "type": "CDM"}], "standard_charges": [{"gross_charge": 73.84, "setting": "both", "billing_class": "facility"}]}, {"description": "REP BLADE SAW 10 X 9.0 X X .43MM OSCILLATING SAGITTAL THIN SM BONE PNEUMICRO STRL", "code_information": [{"code": "KM-3101R", "type": "CDM"}], "standard_charges": [{"gross_charge": 44.32, "setting": "both", "billing_class": "facility"}]}, 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SNGL BLADDER DUAL PORT", "code_information": [{"code": "60-7070-006R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "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": 53.07, "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": 53.07, "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": 53.07, "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": 57.46, "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": 161.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ELECTRODE HOOK 3.5MMINTEGRATED HANDPIECE VAPR", "code_information": [{"code": "227305R", "type": "CDM"}], "standard_charges": [{"gross_charge": 339.68, "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": 299.61, "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": 64.76, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT CALF LG", "code_information": [{"code": "DVT20R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.09, "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": 92.99, "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": 55.29, "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": 17.93, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KIT ENDO CTR 4MM SINGLE PORTAL", "code_information": [{"code": "9971R", "type": "CDM"}], "standard_charges": [{"gross_charge": 256.46, "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": 638.32, "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": 222.6, "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": 34.35, "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": 100.11, "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": 284.96, "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": 311.36, "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": 240.26, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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"methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1586.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PROBE ABLATION 3MM 90DEG ASPIRATING SHOULDER MONOPOLAR LOW PROFILE FOR OPES ASPIRATING ABLATOR W", "code_information": [{"code": "AR-9703A-90R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP PUSHER KNOT SIXTH FINGER W/ SUT PASSER", "code_information": [{"code": "AR-1930SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.31, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP CROSS CUT SML", "code_information": [{"code": "ZR-082R", "type": "CDM"}], "standard_charges": [{"gross_charge": 100.11, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP CROSS CUT SML TEAR", "code_information": [{"code": "SR-51-082R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.99, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP MICRO CROSS CUT SML", "code_information": [{"code": "5053-082R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.11, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP RECIP 11MM X 5.3MM SML BONE", "code_information": [{"code": "KM5100-37-113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RASP SURG 6.5MM LG MICRO CROSS CUT RECIPROCATING HALL", "code_information": [{"code": "5053-083R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.18, "setting": "both", "billing_class": "facility"}]}, {"description": "REP REAMER BONE 8.58MM PILOTED HEADEDINSTR", "code_information": [{"code": "AR-1455R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.51, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RETRIEVER SUT SM YELLOW ARTHRO ROTATOR CUFF LF STRL DISP", "code_information": [{"code": "9892R", "type": "CDM"}], "standard_charges": [{"gross_charge": 117.69, "setting": "both", "billing_class": "facility"}]}, {"description": "REP RETRIEVER SUTURE HOFFEE BLUE LASSO", "code_information": [{"code": "22701R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.13, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE 5.5 X 25.0MM OSCILLATING SML", "code_information": [{"code": "2296-33-414R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE AGGRESSIVE OSCILLATING SML", "code_information": [{"code": "SP-111AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 60 X 35MM DUAL CUT", "code_information": [{"code": "2108-107-4S1R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 85 X 25M SAGITTAL", "code_information": [{"code": "2108-151R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE SAGITTAL 9 X 25MM OSCILLATING", "code_information": [{"code": "KM3-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.27, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BONE OSCILLATING 25 X 90 X 1.19MM STAND WIDE", "code_information": [{"code": "5071-323R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.82, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SCISSOR ENDO .5IN X 35 CM 5 MM CURVEDINSTR DISP", "code_information": [{"code": "ES0101R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.87, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 5.5MM 70MM GRAY CONICAL TIP DIST HOLE THRD W/ CANNULA AND OBTURATOR W/", "code_information": [{"code": "4616R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.71, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 5.5MM 70MM ORANGE CONICAL TIP THRD W/ CANNULA AND OBTURATOR WITHOUT DI", "code_information": [{"code": "7204895R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.71, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 70MM SHLDR WITHOUT FENESTRATION BLUNT TROCAR DOUBLE SEAL STRL DISP", "code_information": [{"code": "9718R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.12, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SET CNULA 7MM 70MM LIME GRN CONICAL TIP THRD W/ CANNULA AND OBTURATOR WITHOUT DI", "code_information": [{"code": "7204896R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.71, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SHAVER BLADE TOMCAT FORMULA SERIES YELLOW/WHI STR", "code_information": [{"code": "375-535-000R", "type": "CDM"}], "standard_charges": [{"gross_charge": 114.96, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SHAVER CUDA 30 LRG MERLIN BENDABLE", "code_information": [{"code": "P9356R", "type": "CDM"}], "standard_charges": [{"gross_charge": 100.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SLEEVE CMPR STD KN-HI SCD ANEMB LTWT BRTHBL NS DISP 17IN", "code_information": [{"code": "DVT10R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.09, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP ASPIRATION 25DEG 12DEG PURPLE PINK BYPASS SYS MINI FLARED TURBOSONICS KELMAN", "code_information": [{"code": "8065751177R", "type": "CDM"}], "standard_charges": [{"gross_charge": 233.73, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 0.9MM ABS KELMAN 30D TAPERED POINT", "code_information": [{"code": "8065750263R", "type": "CDM"}], "standard_charges": [{"gross_charge": 116.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 30DEG 0.9MM TURBO SONIC ABS OZIL MINI FLARED", "code_information": [{"code": "8065751176R", "type": "CDM"}], "standard_charges": [{"gross_charge": 153.56, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 30DEG X .09MM RND MICRO FLARED", "code_information": [{"code": "8065740837R", "type": "CDM"}], "standard_charges": [{"gross_charge": 116.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TIP PHACO 45DEG MICRO KELMAN", "code_information": [{"code": "8065750852R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET 18 X 4 DISP SINGLE PORT RED", "code_information": [{"code": "5921-218-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET 24IN DPSB W LUER LOCK", "code_information": [{"code": "60-7070-004R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET COMPRESSION LUER LOCK 18IN RED", "code_information": [{"code": "60-7070-003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 24IN X 4IN YELLOW SNGL BLADDER W/ 40IN TUBING COLOR CUFF", "code_information": [{"code": "5921-024-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 30IN X 4IN ROYAL BLUE SNGL BLADDER DUAL PORT W/ 40IN TUBI", "code_information": [{"code": "5921-030-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET CYLINDRICAL 34IN X 4IN PURPLE SNGL BLADDER W/ 40IN TUBING COLOR CUFF", "code_information": [{"code": "5921-034-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET PNEUMATIC 34IN X 4IN BLACK 2 PART QUICK REPROCESS", "code_information": [{"code": "5921-024-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET PROTECTION 18IN X 3IN RED COLOR CUFF CYLINDRICAL", "code_information": [{"code": "5921-018-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET STERILE DISP  24 INCH", "code_information": [{"code": "60-7070-105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TOURNIQUET STERILE DISP 12 INCH", "code_information": [{"code": "60-7070-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR AUDIBLE DILATING SHIELD", "code_information": [{"code": "CD7012GR", "type": "CDM"}], "standard_charges": [{"gross_charge": 138.91, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR ENDOPATH XCEL 100MM STAB SLEEVE", "code_information": [{"code": "CB11LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.91, "setting": "both", "billing_class": "facility"}]}, {"description": "REP TROCAR VERSAPORT 5MM TO 11MM W/ RADIOLUCENT SLEEVE", "code_information": [{"code": "179095PR", "type": "CDM"}], "standard_charges": [{"gross_charge": 127.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND ELECTRODE 3.5MM SIDE EFFECT ONE PIECE VAPRINSTR", "code_information": [{"code": "227301R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 339.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND EVAC 70D TONSIL ADENOID PLASMA SUCTION", "code_information": [{"code": "EIC 5874-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 345.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND SUCTION 3MM 70DEG ICW COVAC", "code_information": [{"code": "ASC 3730-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.62, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND SUPER MULTIVAC 50 SUCTION 50DEG SOFT TISSUE", "code_information": [{"code": "ASC 4830-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 272.62, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WAND TRISTAR 3MM 50D SUCTION INTEGRATED CABLE", "code_information": [{"code": "ASC 4630-01R", "type": "CDM"}], "standard_charges": [{"gross_charge": 283.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REP WANDINTEGRATED TABLE 70 DEGREEE XTRA EVAC", "code_information": [{"code": "EICA5872-01R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 196.65, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON", "code_information": [{"code": "27650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 831.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANAL FISTULA", "code_information": [{"code": "46288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 732.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2223.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARM/LEG NERVE", "code_information": [{"code": "64857", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1247.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2097.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2758.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2555.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2993.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2568.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1410.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1804.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1940.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1354.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1940.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1561.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2487.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2483.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BICEPS TENDON", "code_information": [{"code": "23430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 932.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER DEFECT", "code_information": [{"code": "57288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 887.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 715.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 668.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 929.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 937.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2209.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1599.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1793.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 896.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1729.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2502.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1750.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35226", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 989.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1444.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1203.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1797.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1947.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2047.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1216.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1172.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1030.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1735.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1830.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1942.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1100.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1743.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1061.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1235.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1916.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1618.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1865.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1689.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1876.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 288.77, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 288.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BROW DEFECT", "code_information": [{"code": "67900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 880.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2194.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 970.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1209.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1414.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1193.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1224.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1278.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1366.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 835.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARM ARTERY", "code_information": [{"code": "35045", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1139.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1316.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1187.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1193.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1587.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2057.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2096.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2222.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1578.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1876.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1645.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1295.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1467.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFORMITY OF TOE", "code_information": [{"code": "28313", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEGENERATED KNEECAP", "code_information": [{"code": "27418", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1009.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67107", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1277.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67108", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1349.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1197.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA CRTX", "code_information": [{"code": "67101", "type": "CPT"}], "standard_charges": [{"minimum": 450.29, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA PC", "code_information": [{"code": "67105", "type": "CPT"}], "standard_charges": [{"minimum": 401.44, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1061.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 964.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2376.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2438.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1568.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1982.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69631", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1065.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1557.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW DEB/ATTCH OPEN", "code_information": [{"code": "24359", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 815.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW PERC", "code_information": [{"code": "24357", "type": "CPT"}], "standard_charges": [{"minimum": 516.48, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 516.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW W/DEB OPEN", "code_information": [{"code": "24358", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 660.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1934.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1180.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1800.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1210.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3159.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 549.81, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 549.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67901", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67903", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67904", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 998.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67906", "type": "CPT"}], "standard_charges": [{"minimum": 580.97, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 580.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67908", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 731.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67914", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 652.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"minimum": 419.55, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67916", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 817.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67917", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 836.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67921", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"minimum": 410.35, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 410.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67923", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67924", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67930", "type": "CPT"}], "standard_charges": [{"minimum": 499.6, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 499.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 811.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1363.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1454.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FIBULA NONUNION", "code_information": [{"code": "27726", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1158.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1766.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26418", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26432", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 715.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26433", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26350", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 973.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26356", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26357", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1125.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1003.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26373", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1143.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 629.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1816.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1906.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1264.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1052.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON SHEATH", "code_information": [{"code": "25275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 826.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25263", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25265", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 912.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 622.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25272", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 706.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25274", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2562.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2621.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2227.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2285.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2419.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2312.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2865.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2803.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2860.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2780.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 676.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1909.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT", "code_information": [{"code": "26540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 896.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1056.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26542", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND TENDON", "code_information": [{"code": "26410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 789.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2006.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2284.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2302.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2279.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2217.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1952.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1411.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2044.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HUMERUS WITH GRAFT", "code_information": [{"code": "24435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1325.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ING HERNIA SLIDING", "code_information": [{"code": "49525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66682", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 338.96, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 380.14, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 380.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 448.27, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 457.66, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 457.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 706.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1685.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2274.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3621.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1754.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 820.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 627.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1201.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1331.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1739.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1501.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 962.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 965.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2449.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40831", "type": "CPT"}], "standard_charges": [{"minimum": 414.7, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 806.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MULTI-COMP PENIS PROS", "code_information": [{"code": "54408", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MUSCLES OF HAND", "code_information": [{"code": "26591", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 649.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTUM DEFECT", "code_information": [{"code": "30630", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 808.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL STENOSIS", "code_information": [{"code": "30465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1230.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64832", "type": "CPT"}], "standard_charges": [{"minimum": 373.36, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 373.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 411.88, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 411.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 222.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION CARPAL BONE", "code_information": [{"code": "25431", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION HAND", "code_information": [{"code": "26546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1312.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ACHILLES TENDON", "code_information": [{"code": "27654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 902.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 916.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1404.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1107.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 852.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 752.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27695", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 619.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27698", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 796.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENTS", "code_information": [{"code": "27696", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2611.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2067.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM NERVES", "code_information": [{"code": "64861", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1918.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 912.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1089.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 155.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 155.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 168.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 155.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL BULGE", "code_information": [{"code": "57268", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 608.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1587.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CIRCUMCISION", "code_information": [{"code": "54163", "type": "CPT"}], "standard_charges": [{"minimum": 278.12, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 278.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4306.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4730.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5112.87, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5112.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 7001.03, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7001.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1070.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1160.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIGIT NERVE", "code_information": [{"code": "64831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 852.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK WITH LAMINECTOMY 63709", "code_information": [{"code": "63709", "type": "CPT"}, {"code": "1481928", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1395.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK-NO LAMINECTOMY 63707", "code_information": [{"code": "63707", "type": "CPT"}, {"code": "1481927", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1192.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69610", "type": "CPT"}], "standard_charges": [{"minimum": 509.3, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 509.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 982.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1832.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE SOCKET WOUND", "code_information": [{"code": "65290", "type": "CPT"}], "standard_charges": [{"minimum": 563.35, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65270", "type": "CPT"}], "standard_charges": [{"minimum": 375.15, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 703.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"minimum": 435.61, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 435.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1261.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 935.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1007.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1269.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 582.12, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 582.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT BONES", "code_information": [{"code": "28320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 772.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 671.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28208", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 662.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 731.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 576.81, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 576.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64834", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 880.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64835", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64836", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2379.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3763.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1916.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2145.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2332.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2366.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2376.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2499.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1915.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2495.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2971.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4932.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HUMERUS", "code_information": [{"code": "24430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1281.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYDROCELE", "code_information": [{"code": "55060", "type": "CPT"}], "standard_charges": [{"minimum": 476.22, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 476.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3096.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1578.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE CARTILAGE", "code_information": [{"code": "27403", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 805.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27407", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 986.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENTS", "code_information": [{"code": "27409", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1182.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEECAP TENDON", "code_information": [{"code": "27380", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 880.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 963.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG NERVE", "code_information": [{"code": "64840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 10972.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1167.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27658", "type": "CPT"}], "standard_charges": [{"minimum": 476.28, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 476.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27659", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 597.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27664", "type": "CPT"}], "standard_charges": [{"minimum": 458.43, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 458.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27665", "type": "CPT"}], "standard_charges": [{"minimum": 531.84, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 531.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOW BACK NERVES", "code_information": [{"code": "64862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1633.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1482.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1264.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MENINGOCELE LESS THAN 5 CM DIAMETER 63700", "code_information": [{"code": "63700", "type": "CPT"}, {"code": "39099785", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3390.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2034.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2203.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1680.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MENINGOCELE; LARGER THAN 5CM DIAMETER 63702", "code_information": [{"code": "63702", "type": "CPT"}, {"code": "42715598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3387.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1820.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 929.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF METATARSALS", "code_information": [{"code": "28322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1080.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3340.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2923.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2983.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "11760", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 248.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NASAL SEPTUM", "code_information": [{"code": "30520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PENIS", "code_information": [{"code": "54440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PERINEUM", "code_information": [{"code": "56810", "type": "CPT"}], "standard_charges": [{"minimum": 321.7, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE", "code_information": [{"code": "45560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 845.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 744.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1567.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED TENDON", "code_information": [{"code": "24342", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 947.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 941.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER", "code_information": [{"code": "23420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1196.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1737.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 615.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2120.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2332.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 865.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1662.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1432.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH MUSCLE", "code_information": [{"code": "27385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 776.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1073.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TOE DISLOCATION", "code_information": [{"code": "28675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 782.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1028.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 951.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 321.03, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 321.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 690.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 602.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 969.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 496.16, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 496.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 316.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 316.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "56800", "type": "CPT"}], "standard_charges": [{"minimum": 302.68, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 302.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "57200", "type": "CPT"}], "standard_charges": [{"minimum": 404.28, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 404.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 839.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26561", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1247.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26562", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1726.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1659.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2119.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1719.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 858.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1040.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1069.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 438.09, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 438.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE PHARYNX/UVULA", "code_information": [{"code": "42145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 814.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 821.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 977.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1134.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1501.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2082.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2472.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1818.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2211.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS & ULNA", "code_information": [{"code": "25415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1181.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS OR ULNA", "code_information": [{"code": "25400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 975.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1576.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1580.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM & VAGINA", "code_information": [{"code": "57250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 747.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1190.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1796.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1510.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF ACUTE", "code_information": [{"code": "23410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1010.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF CHRONIC", "code_information": [{"code": "23412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1045.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1661.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 596.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 763.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SCIATIC NERVE", "code_information": [{"code": "64858", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1404.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33813", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1897.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1740.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2262.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1150.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1167.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1320.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23462", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1289.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1352.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23466", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1368.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2647.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3370.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2735.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 883.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1950.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2077.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"minimum": 483.73, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 483.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TEAR DUCTS", "code_information": [{"code": "68700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 699.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TESTIS INJURY", "code_information": [{"code": "54670", "type": "CPT"}], "standard_charges": [{"minimum": 509.83, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 509.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1187.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 387.71, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 387.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TOE DISLOCATION", "code_information": [{"code": "28645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41250", "type": "CPT"}], "standard_charges": [{"minimum": 442.59, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 442.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 560.89, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41252", "type": "CPT"}], "standard_charges": [{"minimum": 455.31, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 455.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TOOTH SOCKET", "code_information": [{"code": "41874", "type": "CPT"}], "standard_charges": [{"minimum": 518.08, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 518.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 195.1, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36576", "type": "CPT"}], "standard_charges": [{"minimum": 467.54, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 917.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5850.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5850.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1382.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 864.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 603.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57311", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 678.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1381.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA/PERINEUM", "code_information": [{"code": "57210", "type": "CPT"}], "standard_charges": [{"minimum": 471.71, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 471.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1072.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1886.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1368.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1421.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1483.79, "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": 584.01, "maximum": 6923.0, "gross_charge": 1690.0, "discounted_cash": 6957.28, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1108.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WEBBED TOE(S)", "code_information": [{"code": "28345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 676.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": [{"minimum": 525.93, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 525.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31614", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 856.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "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": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 349.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031", "code_information": [{"code": "12031", "type": "CPT"}, {"code": "1482003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.6-7.5 CM  SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12032", "code_information": [{"code": "12032", "type": "CPT"}, {"code": "1482005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 398.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.6-7.5 CM NECK/HANDS/FEET/EXTERNAL GENITALIA 12042", "code_information": [{"code": "12042", "type": "CPT"}, {"code": "1482004", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 508.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 406.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WRIST JOINTS", "code_information": [{"code": "25447", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR-COMPLEX TRUNK 2.6CM -7.5CM 13101", "code_information": [{"code": "13101", "type": "CPT"}, {"code": "1481842", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 519.58, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 924.07, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 519.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT ACHILLES TENDON", "code_information": [{"code": "27652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 829.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT EYE LESION", "code_information": [{"code": "66225", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1075.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 948.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1039.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26434", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 912.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26352", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1062.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26358", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1230.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26372", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1182.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26392", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1280.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 917.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT KNEECAP TENDON", "code_information": [{"code": "27381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1022.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1640.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28202", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 797.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1525.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH MUSCLE", "code_information": [{"code": "27386", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1066.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1099.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1498.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1409.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1355.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1243.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25425", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1176.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT WRIST BONE", "code_information": [{"code": "25440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 933.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/REVISE WRIST JOINT", "code_information": [{"code": "25320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1227.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 536.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPEAT THYROID SURGERY", "code_information": [{"code": "60260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1287.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1542.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1601.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1660.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1670.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1416.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 733.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 888.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1173.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1406.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"minimum": 255.44, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1721.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE EYE FLUID", "code_information": [{"code": "67025", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 743.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1956.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3360.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"minimum": 574.64, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 574.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36582", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1131.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1652.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1491.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2751.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2338.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 995.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 673.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 731.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2783.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3504.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3120.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4083.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3848.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3957.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF CONTACT LENS", "code_information": [{"code": "92326", "type": "CPT"}], "standard_charges": [{"minimum": 51.05, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 51.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3435.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2821.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT/IRRIGATION OR REVISION  OF LUMBOSUBARACHNOID SHUNT 63744", "code_information": [{"code": "63744", "type": "CPT"}, {"code": "1482011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "gross_charge": 1690.0, "discounted_cash": 4271.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 937.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "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": 584.01, "maximum": 6090.0, "gross_charge": 3437.0, "discounted_cash": 10972.46, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1071.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3827.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3237.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2423.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2115.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3292.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4594.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2430.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2169.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 471.56, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 471.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 189.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 189.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"minimum": 444.5, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 164.69, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION INTRAOCULAR LENS", "code_information": [{"code": "66825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 983.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 555.78, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 361.37, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 361.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 150.91, "maximum": 4936.0, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR ELBOW LAT LIGMNT W/TISS", "code_information": [{"code": "24343", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR ELBW MED LIGMNT W/TISSU", "code_information": [{"code": "24345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 232.68, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 232.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2707.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1393.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2920.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 683.15, "maximum": 683.15, "discounted_cash": 986.77, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRIZA, 1CM", "code_information": [{"code": "Q4143", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 132.92, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 132.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 584.01, "discounted_cash": 12.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREMOVE WRIST TENDON LESION", "code_information": [{"code": "25112", "type": "CPT"}], "standard_charges": [{"minimum": 498.47, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 498.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 904.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA REDUCE", "code_information": [{"code": "49555", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 760.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA BLOCKED", "code_information": [{"code": "49521", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA REDUCE", "code_information": [{"code": "49520", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 794.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 223.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 223.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2510.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1717.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM < 5 CM", "code_information": [{"code": "21935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1255.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1801.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1592.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 995.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 794.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE", "code_information": [{"code": "28341", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 873.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1197.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM < 2 CM", "code_information": [{"code": "21015", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 850.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2425.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1280.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1424.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1084.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2949.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3279.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2454.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2167.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1705.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT INFERIOR TURBINATE", "code_information": [{"code": "30140", "type": "CPT"}], "standard_charges": [{"minimum": 390.41, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 390.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1527.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1403.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3375.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1163.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1612.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1409.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1756.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2004.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 595.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 983.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1755.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1940.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1383.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1246.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1336.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1883.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM < 5 CM", "code_information": [{"code": "27329", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1270.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3373.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2521.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3065.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2546.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3503.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3241.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4014.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3583.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4036.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1043.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTOR MERLIN 3.5MM FULL RADIUS REPROCESS STERLINGINSTR", "code_information": [{"code": "C9248R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.41, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR CARDIOTOMY CELL SAVER 20 MICRON 3LT RAISED FILTER", "code_information": [{"code": "220-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR CELL SAVER BLOOD COLLECTION", "code_information": [{"code": "EL2120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR COLLECTION 3LT W/ 150 UM FILTER", "code_information": [{"code": "205-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERVOIR SUCT 100CC BULB EVACUATOR SI FOR CLOSED WOUND DRAINAGE LF", "code_information": [{"code": "DYNJWE1305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.18, "setting": "both", "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 226.16, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1321.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESOLVE MATRIX PER SQ CM", "code_information": [{"code": "A2024", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP SYNCYTIAL VIRUS AG IA", "code_information": [{"code": "87420", "type": "CPT"}], "standard_charges": [{"minimum": 12.52, "maximum": 584.01, "discounted_cash": 18.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 12-25 TARGETS", "code_information": [{"code": "87633", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 830.16, "discounted_cash": 541.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 767.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 767.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 830.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 767.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 767.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 3-5 TARGETS", "code_information": [{"code": "87631", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 584.01, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 6-11 TARGETS", "code_information": [{"code": "87632", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 584.01, "discounted_cash": 283.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 393.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 393.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 425.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 393.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 393.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 196.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 196.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 247.82, "discounted_cash": 357.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATOR MOTION MGMT SIMUL", "code_information": [{"code": "77293", "type": "CPT"}], "standard_charges": [{"minimum": 393.06, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 431.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 431.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 466.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 431.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 431.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 393.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY FLOW VOLUME LOOP", "code_information": [{"code": "94375", "type": "CPT"}], "standard_charges": [{"minimum": 36.17, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [{"code": "178", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4427.74, "maximum": 13784.27, "discounted_cash": 8726.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9097.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9097.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13784.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12076.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7957.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6792.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4427.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7214.44, "maximum": 21869.83, "discounted_cash": 13972.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14434.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14434.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21869.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19160.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12624.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10776.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7214.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3435.17, "maximum": 9855.74, "discounted_cash": 6750.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6504.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6504.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9855.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8634.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5689.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4856.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3435.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4955.27, "maximum": 14921.26, "discounted_cash": 9576.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9848.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9848.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14921.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13073.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8613.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7352.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4955.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7800.43, "maximum": 22160.27, "discounted_cash": 15790.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14625.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14625.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22160.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19415.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12792.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10919.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7800.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "182", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3737.76, "maximum": 14735.43, "discounted_cash": 6739.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9725.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9725.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14735.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12910.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8506.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7261.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3737.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3189.37, "maximum": 6472.3, "discounted_cash": 7219.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4271.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4271.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6472.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5670.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3736.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3189.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3619.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 12.08, "maximum": 584.01, "discounted_cash": 17.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11977.8, "maximum": 35330.63, "discounted_cash": 24577.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23318.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23318.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35330.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30954.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20395.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17409.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11977.8, "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": 28863.11, "maximum": 82431.7, "discounted_cash": 57534.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 54405.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 54405.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 82431.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 72221.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 47584.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 40620.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 28863.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY VIRUS ANTIBODY", "code_information": [{"code": "86756", "type": "CPT"}], "standard_charges": [{"minimum": 14.3, "maximum": 584.01, "discounted_cash": 20.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3642.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN 1 SQ CM", "code_information": [{"code": "Q4191", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTRATA, PER SQ CM", "code_information": [{"code": "A2007", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETAINER NUT", "code_information": [{"code": "3.820.110.02S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 339.36, "setting": "both", "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4534.85, "maximum": 11380.9, "discounted_cash": 9066.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7511.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7511.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11380.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9971.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6569.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5608.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4534.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8741.25, "maximum": 17738.96, "discounted_cash": 19015.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11707.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11707.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17738.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15541.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10240.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8741.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9329.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2942.9, "maximum": 8674.7, "discounted_cash": 5650.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5725.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5725.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8674.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7600.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5007.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4274.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2942.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICYTE/HGB CONCENTRATE", "code_information": [{"code": "85046", "type": "CPT"}], "standard_charges": [{"minimum": 5.01, "maximum": 584.01, "discounted_cash": 7.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"minimum": 144.91, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRACTOR 12MM ENDO PADDLE", "code_information": [{"code": "173046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.04, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR LAP 10MM FAN ENDO RETRACT II DISP", "code_information": [{"code": "176647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1046.72, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR O C-SECTIONS", "code_information": [{"code": "G6313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 312.09, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR RNG 31.8CM X 18.3CM DOUBLE PEEL POUCH NORYL RESIN W/ 2 CATH CLIPS LF S", "code_information": [{"code": "3304GR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.41, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SYS WOUND  5 - 9CM INCISIO C8302", "code_information": [{"code": "C8302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR WOUND PROTECTOR ALEXIS MEDIUM", "code_information": [{"code": "C8402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR WOUND SM 2.5CM TO 6CM ALEXIS PROTECTOR DISP", "code_information": [{"code": "C8301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 315.31, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL SYSTEM INZII ENDO POUCH", "code_information": [{"code": "CD004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 728.21, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER ENDO-CATCH II 15MM 173049", "code_information": [{"code": "173049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 823.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER SUT 10.1IN HEWSON FOR REPAIRING ACL AND PCL LIGAMENT TEARS LF STRLINST", "code_information": [{"code": "71111579R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.79, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER SUT 10.1IN HEWSON UNIVERSALINSTR", "code_information": [{"code": "7111-1579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 559.94, "setting": "both", "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 17.63, "maximum": 584.01, "discounted_cash": 25.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETROGRADE INTUBATION SET", "code_information": [{"code": "G10554", "type": "CDM"}], "standard_charges": [{"gross_charge": 1322.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLC/RMV THRC VRT TETHRG", "code_information": [{"code": "22838", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2293.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2844.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2871.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 3613.0, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 38581.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1069.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1001.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1523.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 34.28, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23473", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1907.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23474", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2054.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1658.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2029.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"minimum": 119.04, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 992.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1556.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3160.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3095.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2620.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 18136.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1606.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1659.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EXTERNAL EAR", "code_information": [{"code": "69300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 867.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67311", "type": "CPT"}], "standard_charges": [{"minimum": 529.95, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 529.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 529.95, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 529.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 320.43, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 320.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 136.41, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 787.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 191.9, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1312.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1659.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2886.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2681.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1943.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2415.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE WITH IMPLANT", "code_information": [{"code": "65093", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 25.52, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"minimum": 181.43, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}], "standard_charges": [{"minimum": 356.98, "maximum": 4936.0, "discounted_cash": 1246.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 356.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 514.02, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 740.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67911", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68330", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 731.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68362", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 758.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT", "code_information": [{"code": "26535", "type": "CPT"}], "standard_charges": [{"minimum": 555.95, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 687.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 635.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER/TOE NERVE", "code_information": [{"code": "64702", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 486.73, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 486.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1099.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1222.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FINGER TENDON", "code_information": [{"code": "26390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1121.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FOOT NERVE", "code_information": [{"code": "64704", "type": "CPT"}], "standard_charges": [{"minimum": 414.1, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1192.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HERNIA & SPERM VEINS", "code_information": [{"code": "55540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 704.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27137", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1739.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP", "code_information": [{"code": "27437", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 824.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE JOINT", "code_information": [{"code": "26530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 674.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE WITH IMPLANT", "code_information": [{"code": "26531", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 779.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 297.61, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 297.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 940.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27690", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27691", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 934.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 670.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1210.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1273.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69641", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1239.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69642", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1582.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69643", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1451.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69644", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1827.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1798.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1906.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1094.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1422.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1363.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 607.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 844.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1066.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 950.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1138.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1225.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1439.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1036.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1122.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25375", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1164.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS OR ULNA", "code_information": [{"code": "25370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1241.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1822.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2080.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55530", "type": "CPT"}], "standard_charges": [{"minimum": 439.69, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 439.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55535", "type": "CPT"}], "standard_charges": [{"minimum": 535.85, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 535.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3579.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3668.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3667.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1982.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2070.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"minimum": 346.6, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 346.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 868.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1081.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1159.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 759.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67316", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 811.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 1", "code_information": [{"code": "53400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 976.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 2", "code_information": [{"code": "53405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1064.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2163.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1124.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 599.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2492.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 650.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST JOINT", "code_information": [{"code": "25332", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1026.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST/FOREARM TENDON", "code_information": [{"code": "25280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 704.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 999.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 759.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68326", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 747.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/IMPLANT FINGER JOINT", "code_information": [{"code": "26536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 965.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 791.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURORECEIVER", "code_information": [{"code": "61888", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE SLING REPAIR", "code_information": [{"code": "57287", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 958.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION / REMOVAL PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER 64595", "code_information": [{"code": "64595", "type": "CPT"}, {"code": "4327087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 462.56, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 4371.19, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 462.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2339.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION INC. REPLACE SPINAL NEUROSTIMULATOR ELEC  PLATE VIA LAMINOTOMY/ECTOMY 63664", "code_information": [{"code": "63664", "type": "CPT"}, {"code": "1764941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 10180.0, "gross_charge": 3437.0, "discounted_cash": 13931.72, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1137.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION INC. REPLACEMENT OF SPINAL NEUROSTIMULATOR ELECTRODE W/FLOURO 63663", "code_information": [{"code": "63663", "type": "CPT"}, {"code": "1740094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 10180.0, "gross_charge": 3437.0, "discounted_cash": 7968.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1263.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1499.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ANKLE JOINT", "code_information": [{"code": "27700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 882.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AORTIC VALVE", "code_information": [{"code": "92986", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1534.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ARM NERVE(S)", "code_information": [{"code": "64713", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 979.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BIG TOE", "code_information": [{"code": "28310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 752.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1672.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER NECK", "code_information": [{"code": "52500", "type": "CPT"}], "standard_charges": [{"minimum": 473.91, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 473.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1258.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CALF TENDON", "code_information": [{"code": "27687", "type": "CPT"}], "standard_charges": [{"minimum": 578.99, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 578.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57700", "type": "CPT"}], "standard_charges": [{"minimum": 422.82, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 422.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57720", "type": "CPT"}], "standard_charges": [{"minimum": 398.24, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 398.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59320", "type": "CPT"}], "standard_charges": [{"minimum": 176.14, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 276.99, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 276.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2785.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2587.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2657.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2555.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1007.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1152.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 799.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1300.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1450.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CRANIAL NERVE", "code_information": [{"code": "64716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1142.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 842.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 705.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 493.31, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 493.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67880", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 630.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 770.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67950", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67961", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67966", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 889.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1051.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 892.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FINGER", "code_information": [{"code": "26499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1119.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT", "code_information": [{"code": "28116", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT AND ANKLE", "code_information": [{"code": "28262", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1957.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT BONES", "code_information": [{"code": "28737", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 851.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT FASCIA", "code_information": [{"code": "28250", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 796.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28238", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 915.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28261", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1489.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1895.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1954.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1626.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1757.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2116.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1750.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2024.42, "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": 15286.67, "maximum": 42109.89, "discounted_cash": 31532.61, "estimated_discounted_cash": 57268.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27792.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27792.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42109.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36893.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24308.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20750.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15286.67, "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": 22737.2, "maximum": 48739.11, "discounted_cash": 46543.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 32168.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32168.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48739.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42702.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28135.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 24017.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22737.2, "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": 11707.79, "maximum": 37937.72, "discounted_cash": 24570.86, "estimated_discounted_cash": 84652.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25039.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25039.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37937.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33238.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21899.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18694.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11707.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP TENDON", "code_information": [{"code": "27097", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 849.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1386.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1021.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1289.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1320.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 749.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44314", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1237.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 532.04, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 532.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66761", "type": "CPT"}], "standard_charges": [{"minimum": 401.18, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 246.44, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 246.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 493.08, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1396.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1682.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 984.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1013.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1062.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1004.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 288.44, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 288.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 789.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15821", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1797.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG TENDON", "code_information": [{"code": "27685", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1537.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 553.63, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 553.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1591.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1820.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2083.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1584.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 434.19, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 434.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 735.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 679.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 645.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30120", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 689.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1402.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1705.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2171.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1016.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30462", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1673.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 793.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 913.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 784.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 517.17, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 517.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2196.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2775.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1882.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2664.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1267.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 830.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25355", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 947.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCIATIC NERVE", "code_information": [{"code": "64712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 735.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55175", "type": "CPT"}], "standard_charges": [{"minimum": 456.88, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 456.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55180", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 841.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TESTIS", "code_information": [{"code": "54660", "type": "CPT"}], "standard_charges": [{"minimum": 450.08, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF THIGH MUSCLES", "code_information": [{"code": "27430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 922.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOE", "code_information": [{"code": "28312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2945.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2970.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ULNA", "code_information": [{"code": "25360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 806.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 929.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27422", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 922.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 629.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1126.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53450", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53460", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 568.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"minimum": 414.69, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 414.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1317.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1079.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 778.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "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": 400.18, "maximum": 10180.0, "gross_charge": 4737.0, "discounted_cash": 4371.19, "estimated_discounted_cash": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10180.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 400.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "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": 333.94, "maximum": 4936.0, "gross_charge": 3387.0, "discounted_cash": 4371.19, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1354.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2032.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2201.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", "code_information": [{"code": "21275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1013.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2493.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7107.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY BOTH COMPONENTS W/ OR W/O ALLOGRAFT 27134", "code_information": [{"code": "27134", "type": "CPT"}, {"code": "1744366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2238.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY FEMORAL COMP. W/ OR W/O GRAFT 27138", "code_information": [{"code": "27138", "type": "CPT"}, {"code": "1807654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 21687.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1805.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 21687.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17827.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL KNEE ARTHROPLASTY W/ OR W/O ALLOGRAFT 1 COMPONENT 27486", "code_information": [{"code": "27486", "type": "CPT"}, {"code": "1480021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 4737.0, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1683.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL KNEE ARTHROPLASTY W/ OR W/O ALLOGRAFT FEMORAL AND ENTIRE TIBIAL COMPONENT 27487", "code_information": [{"code": "27487", "type": "CPT"}, {"code": "1480022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "gross_charge": 4737.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2079.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL OF KNEECAP", "code_information": [{"code": "27424", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 928.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVITA, PER SQ CM", "code_information": [{"code": "Q4180", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVITALON 1 SQUARE CM", "code_information": [{"code": "Q4157", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1472.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1416.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ PERI-IMPLT CAPSULE BRST", "code_information": [{"code": "19370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1704.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ RECONSTRUCTED BREAST", "code_information": [{"code": "19380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 975.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVOSHIELD+ AMNIO, PER SQ CM", "code_information": [{"code": "Q4289", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RF ABLTJ NRV NRVTG SI JT", "code_information": [{"code": "64625", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RF SPECTRSC NTRAOP MRGN ASMT", "code_information": [{"code": "546T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RFC1 REPEAT XPNSJ VRNT ALYS", "code_information": [{"code": "378U", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 123.3, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG FULL-DOSE IM", "code_information": [{"code": "90384", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG MINIDOSE IM", "code_information": [{"code": "90385", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 97.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH Type by Blood Center 86901", "code_information": [{"code": "86901", "type": "CPT"}, {"code": "634328", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.69, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 46.7, "estimated_discounted_cash": 11.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 254.59, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"minimum": 254.59, "maximum": 413.0, "discounted_cash": 367.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 381.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QUANT", "code_information": [{"code": "86431", "type": "CPT"}], "standard_charges": [{"minimum": 5.1, "maximum": 584.01, "discounted_cash": 7.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR TEST QUAL", "code_information": [{"code": "86430", "type": "CPT"}], "standard_charges": [{"minimum": 5.53, "maximum": 584.01, "discounted_cash": 7.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 9.68, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 10.02, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 20.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIA NONANTIBODY", "code_information": [{"code": "83519", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 584.01, "discounted_cash": 23.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIB CARTILAGE GRAFT", "code_information": [{"code": "21230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 881.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIGHT HEART CATH", "code_information": [{"code": "93451", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4053.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 948.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIGHT VENTRICULAR RECORDING", "code_information": [{"code": "93603", "type": "CPT"}], "standard_charges": [{"minimum": 117.58, "maximum": 3347.0, "discounted_cash": 1522.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 117.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 117.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 117.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RING RETR 9-14CM LG ALEXIS WND WND RETR SYS DISP STRL", "code_information": [{"code": "C8303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.09, "setting": "both", "billing_class": "facility"}]}, {"description": "RIV3 VACCINE NO PRESERV IM", "code_information": [{"code": "90673", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 627.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 695.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 564.7, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 564.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"minimum": 319.48, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 319.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1390.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 13931.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 448.85, "maximum": 4936.0, "discounted_cash": 38581.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 449.66, "maximum": 14067.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 449.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 466.8, "maximum": 14067.0, "discounted_cash": 39245.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 466.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"minimum": 87.31, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 87.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 839.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW DEEP", "code_information": [{"code": "24201", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 877.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4271.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 848.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 169.62, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 143.19, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 143.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"minimum": 136.53, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 136.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL INTACT BREAST IMPLANT", "code_information": [{"code": "19328", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 679.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"minimum": 239.99, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 239.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 407.83, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 407.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 216.75, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 216.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 183.84, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 781.86, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"minimum": 252.18, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 252.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 655.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"minimum": 404.57, "maximum": 4936.0, "discounted_cash": 4371.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 404.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1515.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL RUPTURED BREAST IMPLANT", "code_information": [{"code": "19330", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 784.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS EA ADDL 10", "code_information": [{"code": "11201", "type": "CPT"}], "standard_charges": [{"minimum": 24.77, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS UP TO&INC 15", "code_information": [{"code": "11200", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 4672.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 168.94, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TIS XPNDR WO INSJ IMPLT", "code_information": [{"code": "11971", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 683.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", "code_information": [{"code": "20665", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2807.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 432.66, "maximum": 14067.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 432.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14067.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 27811.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 3613.0, "maximum": 6090.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 3613.0, "maximum": 4722.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 250MG", "code_information": [{"code": "MED0248", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.44, "setting": "both", "billing_class": "facility"}]}, {"description": "ROCURONIUM 10 MG/ML IV SOL 5 ML VIAL", "code_information": [{"code": "MED0775", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ROCURONIUM 10MG/ML 10ML VIAL", "code_information": [{"code": "MED0492", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.13, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD DUAL DIAMETER 3.5-5.5 188311002", "code_information": [{"code": "188311002", "type": "CDM"}], "standard_charges": [{"gross_charge": 1600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD INFINTIY OCCIPITAL OCCIPITAL ADJUSTABLE TI 3.5 X 200 3600200", "code_information": [{"code": "3600200", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SINGLE USE ELECTRODE PLUNGER CLIP-ON 2701-90027", "code_information": [{"code": "2701-90027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SOLERA  5.5 X 55MM REQ000002980171", "code_information": [{"code": "REQ000002980171", "type": "CDM"}], "standard_charges": [{"gross_charge": 3600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD SOLERA-LONG CCM 6.0 X 500MM 1605200500", "code_information": [{"code": "1605200500", "type": "CDM"}], "standard_charges": [{"gross_charge": 2000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD VOYAGER 60MM PERC 4.75MM CCM 641000060", "code_information": [{"code": "641000060", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD VOYAGER 85MM PERC 4.75MM CCM 641000085", "code_information": [{"code": "641000085", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD VOYAGER CAPPED 80MM 4.75MM CCM 641003080", "code_information": [{"code": "641003080", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROOM/BED: ICU", "code_information": [{"code": "1363824", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 2912.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROOM/BED: Inpatient Private", "code_information": [{"code": "1363822", "type": "CDM"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 2765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.2% 10 ML", "code_information": [{"code": "MED0178", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.62, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 0.2%/NAROPIN 20ML", "code_information": [{"code": "MED0179", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.37, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE 1%/NAROPIN 10ML VIAL", "code_information": [{"code": "MED0180", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.28, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE/ON-Q (NAROPIN/ON-Q) 0.2%/300ML PUMP", "code_information": [{"code": "MED0181", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 267.24, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVACAINE/ON-Q (NAROPIN/ON-Q) 0.2%/400ML PUMP", "code_information": [{"code": "MED0182", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 557.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPIVICAINE HCL 0.5%/ NAROPIN 30ML", "code_information": [{"code": "MED0183", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.59, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTAVIRUS AG IA", "code_information": [{"code": "87425", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS ANTIBODY", "code_information": [{"code": "86759", "type": "CPT"}], "standard_charges": [{"minimum": 16.41, "maximum": 584.01, "discounted_cash": 23.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.41, "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": 96.47, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.75, "maximum": 120.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 194.45, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 194.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 194.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 210.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 194.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 194.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 263.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 261.33, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 261.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 271.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 356.0, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 375.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 842.29, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 778.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 778.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 842.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 778.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 778.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 709.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 465.64, "maximum": 584.01, "discounted_cash": 1618.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 524.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 524.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 567.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 524.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 524.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 465.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1112.64, "discounted_cash": 1787.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1028.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1028.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1112.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1028.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1028.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 912.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 307.06, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 346.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 346.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 375.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 346.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 346.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 689.43, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 637.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 637.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 689.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 637.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 637.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 675.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 90.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 291.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1326.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 357.76, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 357.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 489.59, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 489.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 801.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 753.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4157.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 659.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT TISS XPNDR PERM IMPLT", "code_information": [{"code": "11970", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 NCR/STRN", "code_information": [{"code": "49594", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 RDC", "code_information": [{"code": "49593", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 CM RDC", "code_information": [{"code": "49591", "type": "CPT"}], "standard_charges": [{"minimum": 412.5, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 412.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 NCR/STRN", "code_information": [{"code": "49592", "type": "CPT"}], "standard_charges": [{"minimum": 570.11, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 570.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 NCR/STRN", "code_information": [{"code": "49596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1222.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 RDC", "code_information": [{"code": "49595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 920.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1022.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 RDC", "code_information": [{"code": "49615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 761.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 NCR/STRN", "code_information": [{"code": "49614", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 683.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 RDC", "code_information": [{"code": "49613", "type": "CPT"}], "standard_charges": [{"minimum": 505.78, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 505.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1478.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1056.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 895.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1202.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.5 CM/<", "code_information": [{"code": "12011", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.6-5.0 CM", "code_information": [{"code": "12013", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 191.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 5.1-7.5 CM", "code_information": [{"code": "12014", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 227.76, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 12.6-20.0 CM", "code_information": [{"code": "12016", "type": "CPT"}], "standard_charges": [{"minimum": 351.63, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 351.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 201.88, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 201.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FEM HERNIA INIT BLOCKED", "code_information": [{"code": "49553", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 795.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 996.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1226.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 702.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1187.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 521.11, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 521.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 765.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "type": "CPT"}], "standard_charges": [{"minimum": 538.59, "maximum": 4936.0, "discounted_cash": 8094.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 538.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 753.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 755.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 816.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3144.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/RMDLG", "code_information": [{"code": "30469", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3050.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 897.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1113.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2091.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR REM HERNIA INIT REDUCE", "code_information": [{"code": "49550", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4476.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 728.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [{"code": "12005", "type": "CPT"}], "standard_charges": [{"minimum": 277.41, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 315.86, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRK7.6-12.5CM", "code_information": [{"code": "12004", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 212.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK 2.5CM/<", "code_information": [{"code": "12001", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 150.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [{"code": "12007", "type": "CPT"}], "standard_charges": [{"minimum": 337.1, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 337.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK2.6-7.5CM", "code_information": [{"code": "12002", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 183.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR TDN/MUSC UPR A/E EACH", "code_information": [{"code": "24341", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 936.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 20.32, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 2843.48, "maximum": 2843.48, "discounted_cash": 4107.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RROTECTOR ORTHOPAEDIC WOUND LARGE", "code_information": [{"code": "HR005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1148.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.46, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2421.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV ASSAY W/OPTIC", "code_information": [{"code": "87807", "type": "CPT"}], "standard_charges": [{"minimum": 11.79, "maximum": 584.01, "discounted_cash": 17.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV DNA/RNA AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}], "standard_charges": [{"minimum": 63.18, "maximum": 584.01, "discounted_cash": 91.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 116.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 116.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 126.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 116.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 116.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MAB IM 50MG", "code_information": [{"code": "90378", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 534.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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{"description": "RT Charges - RT -> Continuous Pulse Ox Monitoring", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "2699695", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 31.35, "maximum": 584.01, "gross_charge": 180.0, "discounted_cash": 160.88, "estimated_discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 47.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Evaluation and Education", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "2699692", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 25.91, "maximum": 584.01, "gross_charge": 56.0, "discounted_cash": 273.79, "setting": "both", 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"percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"minimum": 421.71, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 421.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 421.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 456.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 421.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 421.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAFESECURE FOLEY DEVICE", "code_information": [{"code": "SAFESECURE", "type": "CDM"}], "standard_charges": [{"gross_charge": 22.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "S9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3650", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 97.17, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 97.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 97.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 144.94, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 179.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND PROCEDURES", "code_information": [{"code": "139", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6127.7, "maximum": 14952.92, "discounted_cash": 11048.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9869.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9869.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14952.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13100.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8631.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7368.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6127.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALMONELLA ANTIBODY", "code_information": [{"code": "86768", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 584.01, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAME DAY NB DISCHARGE", "code_information": [{"code": "99463", "type": "CPT"}], "standard_charges": [{"minimum": 131.35, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 ANTB QUANTITATIVE", "code_information": [{"code": "86413", "type": "CPT"}], "standard_charges": [{"minimum": 37.92, "maximum": 584.01, "discounted_cash": 66.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 ANTIBODY", "code_information": [{"code": "86769", "type": "CPT"}], "standard_charges": [{"minimum": 37.92, "maximum": 584.01, "discounted_cash": 54.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID19 W/OPTIC", "code_information": [{"code": "87811", "type": "CPT"}], "standard_charges": [{"minimum": 37.33, "maximum": 584.01, "discounted_cash": 53.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV & INF VIR A&B AG IA", "code_information": [{"code": "87428", "type": "CPT"}], "standard_charges": [{"minimum": 66.21, "maximum": 584.01, "discounted_cash": 91.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV CORONAVIRUS AG IA", "code_information": [{"code": "87426", "type": "CPT"}], "standard_charges": [{"minimum": 40.83, "maximum": 584.01, "discounted_cash": 45.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 40.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 40.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 & INF A&B AMP PRB", "code_information": [{"code": "87636", "type": "CPT"}], "standard_charges": [{"minimum": 128.34, "maximum": 584.01, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 25 MCG/.25ML IM", "code_information": [{"code": "91321", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 3MCG TRS-SUC IM", "code_information": [{"code": "91318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 50 MCG/0.5ML IM", "code_information": [{"code": "91322", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 5MCG/0.5ML IM", "code_information": [{"code": "91304", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2&INF A&B&RSV AMP PRB", "code_information": [{"code": "87637", "type": "CPT"}], "standard_charges": [{"minimum": 128.34, "maximum": 584.01, "discounted_cash": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 10MCG TRS-SUC IM", "code_information": [{"code": "91319", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 30MCG TRS-SUC IM", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1639.64, "discounted_cash": 2235.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1516.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1516.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1639.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1516.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1516.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1290.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 879.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 809.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 809.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 875.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 809.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 809.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 879.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS HIGH 50", "code_information": [{"code": "99233", "type": "CPT"}], "standard_charges": [{"minimum": 147.39, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS MODERATE 35", "code_information": [{"code": "99232", "type": "CPT"}], "standard_charges": [{"minimum": 97.19, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS SF/LOW 25", "code_information": [{"code": "99231", "type": "CPT"}], "standard_charges": [{"minimum": 60.74, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NB EM PER DAY HOSP", "code_information": [{"code": "99462", "type": "CPT"}], "standard_charges": [{"minimum": 49.2, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE HIGH MDM 45", "code_information": [{"code": "99310", "type": "CPT"}], "standard_charges": [{"minimum": 222.6, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE LOW MDM 20", "code_information": [{"code": "99308", "type": "CPT"}], "standard_charges": [{"minimum": 107.59, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE MODERATE MDM 30", "code_information": [{"code": "99309", "type": "CPT"}], "standard_charges": [{"minimum": 156.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 156.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE SF MDM 10", "code_information": [{"code": "99307", "type": "CPT"}], "standard_charges": [{"minimum": 57.33, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ PSYC COLLAB CARE MGMT", "code_information": [{"code": "99493", "type": "CPT"}], "standard_charges": [{"minimum": 196.49, "maximum": 584.01, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 473.61, "discounted_cash": 684.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 458.28, "discounted_cash": 661.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 401.25, "discounted_cash": 357.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION ADDL HR", "code_information": [{"code": "96370", "type": "CPT"}], "standard_charges": [{"minimum": 22.94, "maximum": 584.01, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 73.99, "maximum": 584.01, "discounted_cash": 90.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION UP TO 1 HR", "code_information": [{"code": "96369", "type": "CPT"}], "standard_charges": [{"minimum": 190.83, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCALE HOSPITAL 115 VAC AC ADAPTER", "code_information": [{"code": "62472-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 346.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"minimum": 270.94, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCHANZ SCREW 4MMX80 KIT0729", "code_information": [{"code": "KIT0729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1587.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCOPE BRONCH ASCOPE 4 SLIM FLEXIBLE SINGLE-USE STERILE 476001000", "code_information": [{"code": "476001000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5070.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SCOPE PLANTAR FASCIOTOMY", "code_information": [{"code": "29893", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.61, "maximum": 21.39, "discounted_cash": 24.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", 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{"description": "SCREW SOLERA MAS 6.0 X 25MM 55840006025", "code_information": [{"code": "55840006025", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLERA MAS 6.0 X 30MM 55840006030", "code_information": [{"code": "55840006030", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLERA MAS 7.0 X 35MM X0212326", "code_information": [{"code": "X0212326", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLERA MAS 7.0 X 65MM X0212332", "code_information": [{"code": "X0212332", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SOLERA MAS 7.5 X 25MM 55840008525", "code_information": [{"code": "55840008525", "type": "CDM"}], "standard_charges": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 66.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP 2 READG BID 30D", "code_information": [{"code": "99474", "type": "CPT"}], "standard_charges": [{"minimum": 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[{"minimum": 17.74, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL SPERM DETECTION", "code_information": [{"code": "89321", "type": "CPT"}], "standard_charges": [{"minimum": 10.85, "maximum": 584.01, 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL VOL/COUNT/MOT", "code_information": [{"code": "89320", "type": "CPT"}], "standard_charges": [{"minimum": 11.08, "maximum": 584.01, "discounted_cash": 16.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.19, "methodology": "fee schedule"}, {"payer_name": "BLUE 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ANALYSIS", "code_information": [{"code": "G0027", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.85, "maximum": 11.72, "discounted_cash": 8.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/COUNT", "code_information": [{"code": "89310", "type": "CPT"}], "standard_charges": [{"minimum": 7.75, "maximum": 584.01, "discounted_cash": 11.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/HUHNER", "code_information": [{"code": "89300", "type": "CPT"}], "standard_charges": [{"minimum": 8.86, "maximum": 584.01, "discounted_cash": 12.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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[{"code": "MAXP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR ADHSV RESPIRATORY MONITORING OXISENSOR PEDI DISP", "code_information": [{"code": "D20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR ADLT OXIMAX GREATER THAN 30KG", "code_information": [{"code": "MAXA-NS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2572.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR FOREHEAD ADHESIVE MAXFAST", "code_information": [{"code": "MAXFAST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR INFANT OXIMAX MAXI", "code_information": [{"code": "MAXI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR MAXA AHES. SP02", "code_information": [{"code": "MX50065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR MMG SENTIO 8 PACK WITH GROUND", "code_information": [{"code": "2862-02-108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3050.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR MONITOR BRAIN BIS QUATRO 25BX 186-0106", "code_information": [{"code": "186-0106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR NEONATAL/ADLT OXIMAX MAXN", "code_information": [{"code": "MAXN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR NEURO QUATRO BIS", "code_information": [{"code": "600-00-0132-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR OXMTR FINGER TARGET SPO2 CLIP DURASENSOR FOR USE W/ N65 OXIMETER MPB40 OX", "code_information": [{"code": "DS-100A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR REPLACE", "code_information": [{"code": "3771P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR SPO2 FOAM ADULT DISP", "code_information": [{"code": "MS16445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSORIMOTOR EXAMINATION", "code_information": [{"code": "92060", "type": "CPT"}], "standard_charges": [{"minimum": 36.6, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSORINEURAL ACUITY TEST", "code_information": [{"code": "92575", "type": "CPT"}], "standard_charges": [{"minimum": 96.4, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 134.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 134.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 134.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 96.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSORY INTEGRATION", "code_information": [{"code": "97533", "type": "CPT"}], "standard_charges": [{"minimum": 55.7, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 55.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 55.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 60.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENTIOMMG BALL TIP PROBE", "code_information": [{"code": "2862-02-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2972.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 825.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 112.95, "maximum": 584.01, "discounted_cash": 249.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 112.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5378.36, "maximum": 11502.03, "discounted_cash": 10794.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7591.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7591.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11502.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10077.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6639.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5667.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5378.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8991.16, "maximum": 19174.65, "discounted_cash": 17264.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12655.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12655.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19174.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16799.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11068.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9448.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8991.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3847.55, "maximum": 9460.68, "discounted_cash": 7815.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6244.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6244.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9460.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8288.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5461.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4661.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3847.55, "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": 31046.86, "maximum": 103236.12, "discounted_cash": 61800.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 68136.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 68136.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 103236.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 90448.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 59594.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 50871.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 31046.86, "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": 8756.85, "maximum": 18719.02, "discounted_cash": 17368.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12354.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12354.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18719.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16400.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10805.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9224.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8756.85, "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": 4601.35, "maximum": 9679.55, "discounted_cash": 9149.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6388.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6388.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9679.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8480.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5587.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4769.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4601.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRN PROCES", "code_information": [{"code": "24138", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 870.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 110.49, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 138.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 128.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 113.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 149.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 149.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 160.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 149.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 113.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERPINA1 GENE", "code_information": [{"code": "81332", "type": "CPT"}], "standard_charges": [{"minimum": 39.29, "maximum": 584.01, "discounted_cash": 56.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 80.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 39.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 39.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 26.93, "maximum": 584.01, "discounted_cash": 38.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET 70ML PROCESSING", "code_information": [{"code": "391A-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 110IN DEHP 3 LUER LOCK PORTS DRIP CHMBR WITHOUT FILTER CONTINU FLO LF", "code_information": [{"code": "2C8537", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 18.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 110IN TUBING SOLN GRAVITY 10 DROPS PER ML DRIP RATE DRIP CHMBR MALE LU", "code_information": [{"code": "2C6537", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 120IN 21.1 ML PRIMING VOLUME GRAVITY UNIVERSAL SPIKE BACKCHECK VALVE N", "code_information": [{"code": "352415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 20-DROP VENTED NON-VENTED", "code_information": [{"code": "2200-0500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ADMIN 83.66IN 16.3 ML PRIMING VOLUME 20 DROP / ML UNIVERSAL SPIKE ON OFF CLA", "code_information": [{"code": "375152", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 36.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ANESTHESIA 73IN 1.7 ML NONPYROGENIC LUER LOCK ADAPTER STRL", "code_information": [{"code": "2C9216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BASIN SINGLE DOUBLE WRAP 13752-630", "code_information": [{"code": "13752-630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLD COLLECTIN SFTY-LOK 23GX0.75 367283", "code_information": [{"code": "367283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD 180 MICRON FILTER 1 SS 10015414", "code_information": [{"code": "10015414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD COLL 21G X .75 VACUTAINER 367344", "code_information": [{"code": "367344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD COLLECT 23G X .75 INFUSIN 367297", "code_information": [{"code": "367297", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET BLOOD PUMP 1 PORT 33ML 121IN ALARIS", "code_information": [{"code": "2477-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CATH 0.9 ML 7.6IN EXT NON DEHP CLEARLINK LUER ACTIVATED VALVE MALE LUER LOX", "code_information": [{"code": "2N8378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CLLCTN 12IN TUBING 21GA X .75IN BLOOD LUER ADAPTER WINGED VACUTAINER STRL", "code_information": [{"code": "367281", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 4.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CLMP 11IN DECANTING CONTAINS DEHP FOR USE W/ UROMATIC CONTAINERS LF STRL", "code_information": [{"code": "2C4014", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 17.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SET ENEMA BAG 1500 ML FUNNEL TOP PRELUBRICATED NURSING SUPPLY W/ SLIDE CLAMP POL", "code_information": [{"code": "DYND70102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXT 19 ML VOLUME 20 ML DRIP RATE 94IN RATE FLOW REGULATOR NON DEHP 1Y UNVERS", "code_information": [{"code": "V5200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION 15\" MACROBORE 12354-05", "code_information": [{"code": "12354-05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION 36IN 5.5 PV 2 SITE STANDARD BORE ULTRASITEINJECTION DIST END", "code_information": [{"code": "473436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENSION SET CLEARLINK 354220", "code_information": [{"code": "354220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SET EXTENTION 21IN 3.4 ML PRIMING VOLUME 2 PORT MALE LUER LOCK ADAPTER WITHOUT F", "code_information": [{"code": "2C8606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET FLUID WARMING HIGH FLOW DISP", "code_information": [{"code": "24355", "type": "CDM"}], "standard_charges": [{"gross_charge": 165.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HANDPIECEINTERPULSE W/ 10FT SUCTION TUBE", "code_information": [{"code": "210100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HIP W/ COAXIAL BONEINTERPLUS", "code_information": [{"code": "210-110-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFUSOMAT LUER 22 DROP/ML 115IN", "code_information": [{"code": "BMG490100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INTERLINK T-CON EXT MICRO-BORE W 2N3326", "code_information": [{"code": "2N3326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.83, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV ADAPTER MALE NDLS VALVE SMARTSITE", "code_information": [{"code": "2000E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.36, "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": 9.1, "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": 4.97, "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": 20.44, "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": 20.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCESSINGINTEGRATED", "code_information": [{"code": "1150-H-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1820.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77280", "type": "CPT"}], "standard_charges": [{"minimum": 285.15, "maximum": 584.01, "discounted_cash": 168.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 285.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 285.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 308.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 285.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 285.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 305.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77285", "type": "CPT"}], "standard_charges": [{"minimum": 446.69, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 446.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 446.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 483.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 446.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 446.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 521.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77290", "type": "CPT"}], "standard_charges": [{"minimum": 474.92, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 516.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 516.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 558.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 516.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 516.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 474.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RGLTR RATE FLOW ADMIN UNIVERSAL SPIKE BACKCHECK VALVE ON OFF CLAMP RATE FLOW", "code_information": [{"code": "375153 (BRAUN)", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 51.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RGLTR RATE FLOW ADMIN UNIVERSAL SPIKE BACKCHECK VALVE ON OFF CLAMP RATE FLOW", "code_information": [{"code": "375153 (BRAUN)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW 7.5 X 50  ATS 55850042550", "code_information": [{"code": "55850042550", "type": "CDM"}], "standard_charges": [{"gross_charge": 4400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLUTION INTERLINK INJ SITE LL 60DPM 2C6402", "code_information": [{"code": "2C6402", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SYRG ADAPTR DEHP FREE W GEMINI 10010483", "code_information": [{"code": "10010483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE 210IN X 230IN PUMP UNIVERSAL SPIKE LUER LOCK LF", "code_information": [{"code": "H93811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBE SZ 4 CFFD MALLINCKRODT SHILEY TRACHEOSTOMY LF STRL DISP", "code_information": [{"code": "4DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING BLOOD COLLECTION TUBE HOLDER 21 X 3/4", "code_information": [{"code": "982112D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING COMPRESSION SYS SCD EXPRESS", "code_information": [{"code": "9528", "type": "CDM"}], "standard_charges": [{"gross_charge": 144.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TUBING IV 117IN INFUSION ALARIS DEHP FREE 2 PIECE MALE LL", "code_information": [{"code": "2420-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SET UP PORT XRAY EQUIPMENT", "code_information": [{"code": "Q0092", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.53, "maximum": 33.53, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET WARMING FLUID AND BLOOD STANDARD FLOW RANGER DISP", "code_information": [{"code": "24200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET, IV, SECONDARY, 40 INCH W / HANGER DYNDTN1540A", "code_information": [{"code": "DYNDTN1540A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SET-UP CARDIOVERT-DEFIBRILL", "code_information": [{"code": "93745", "type": "CPT"}], "standard_charges": [{"minimum": 523.78, "maximum": 1270.0, "discounted_cash": 384.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 523.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 523.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 565.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 523.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SETINSTR PIN AND DRILL GENESIS", "code_information": [{"code": "114968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SETINTUBATION 14FR RETROGRADE W/ RAPI FIT ADAPTER", "code_information": [{"code": "C-RERO-14.0-70-38J-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 575.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVER CRANIAL NERVE", "code_information": [{"code": "64771", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 740.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 16.18, "maximum": 584.01, "discounted_cash": 23.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 7.19, "maximum": 584.01, "discounted_cash": 10.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 173.93, "maximum": 584.01, "discounted_cash": 251.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 978.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11305", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11310", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 175.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 176.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 200.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11303", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11308", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 188.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 235.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEAR ENDO 5MM", "code_information": [{"code": "176643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS ELECTROSURGICAL 5MM X 14CM CVD PISTAL HANDLE HND CONTROL REPROCESS HARMON", "code_information": [{"code": "ACE14SR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 761.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS ENDO 45CM MONO", "code_information": [{"code": "174601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 765.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC 9CM ADAPTIVE TISSUE TECH BLUE", "code_information": [{"code": "HAR9FM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC ACE PLUS 7 W ADV HARH36", "code_information": [{"code": "HARH36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2596.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC ACE+7 45CM X 5MM HARH45", "code_information": [{"code": "HARH45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2710.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC FOCUS ATT 9CM CURVED HAR9F", "code_information": [{"code": "HAR9F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2398.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC LAP 5MM X 23MM HAR23", "code_information": [{"code": "HAR23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2165.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS HARMONIC LAP 5MM X 36MM HAR36", "code_information": [{"code": "HAR36", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2367.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEARS MINI ENDOSCOPIC 5MM 174301", "code_information": [{"code": "174301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 786.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH SPARE  4.5 INCH ENTRADA 2.0", "code_information": [{"code": "SC-4220-S450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEET EXTREMITY W/ARMBOARD 29405", "code_information": [{"code": "29405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD LIGHT SURG UNIVERSIAL LF STRL", "code_information": [{"code": "8002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIELD SPLASH FOR WOUND LF", "code_information": [{"code": "SS-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIGA-LIKE TOXIN AG IA", "code_information": [{"code": "87427", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 584.01, "discounted_cash": 15.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGELLA ANTIBODY", "code_information": [{"code": "86771", "type": "CPT"}], "standard_charges": [{"minimum": 22.03, "maximum": 584.01, "discounted_cash": 31.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS DX +- SYNOVIAL BX", "code_information": [{"code": "29805", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 592.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG BICP TENODSIS", "code_information": [{"code": "29828", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1115.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG CAPSULORRAPHY", "code_information": [{"code": "29806", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1285.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG COMPL SYNVCT", "code_information": [{"code": "29821", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 736.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DECOMPRESSION", "code_information": [{"code": "29826", "type": "CPT"}], "standard_charges": [{"minimum": 195.97, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DSTL CLAVICLC", "code_information": [{"code": "29824", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 844.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LMTD DBRDMT", "code_information": [{"code": "29822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 681.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LSS&RESCJ ADS", "code_information": [{"code": "29825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 731.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG PRTL SYNVCT", "code_information": [{"code": "29820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 664.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RMVL LOOSE/FB", "code_information": [{"code": "29819", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RPR SLAP LES", "code_information": [{"code": "29807", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1258.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RT8TR CUF RPR", "code_information": [{"code": "29827", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1291.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG XTNSV DBRDMT", "code_information": [{"code": "29823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 738.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "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": 24.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI SKID", "code_information": [{"code": "2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1232.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS OR ULNA", "code_information": [{"code": "25390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 933.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 889.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1707.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 584.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1290.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1519.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [{"code": "511", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7841.15, "maximum": 15912.34, "discounted_cash": 18592.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10502.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10502.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15912.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13941.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9185.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7841.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8752.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [{"code": "510", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10413.26, "maximum": 21132.03, "discounted_cash": 27007.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13947.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13947.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21132.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18514.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12198.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10413.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12755.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "512", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6968.85, "maximum": 14142.16, "discounted_cash": 14801.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9333.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9333.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14142.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12390.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8163.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6968.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7175.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIALIDASE ENZYME ASSAY", "code_information": [{"code": "87905", "type": "CPT"}], "standard_charges": [{"minimum": 11.0, "maximum": 584.01, "discounted_cash": 15.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 24.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIDE BY SIDE CONNECTOR", "code_information": [{"code": "1774-92-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3318.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SIDE SHIELD EYE CLEAR", "code_information": [{"code": "9810-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SIG W/TNDSC BALLOON DILATION", "code_information": [{"code": "45340", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 667.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & DECOMPRESS", "code_information": [{"code": "45337", "type": "CPT"}], "standard_charges": [{"minimum": 135.59, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 135.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & POLYPECTOMY", "code_information": [{"code": "45333", "type": "CPT"}], "standard_charges": [{"minimum": 485.58, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 485.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY AND BIOPSY", "code_information": [{"code": "45331", "type": "CPT"}], "standard_charges": [{"minimum": 425.72, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 425.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FOR BLEEDING", "code_information": [{"code": "45334", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 718.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3275.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/FB REMOVAL", "code_information": [{"code": "45332", "type": "CPT"}], "standard_charges": [{"minimum": 413.83, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 185.31, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 237.9, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 237.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/SUBMUC INJ", "code_information": [{"code": "45335", "type": "CPT"}], "standard_charges": [{"minimum": 432.28, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 432.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/TUMR REMOVE", "code_information": [{"code": "45338", "type": "CPT"}], "standard_charges": [{"minimum": 443.85, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"minimum": 151.18, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 151.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"minimum": 205.07, "maximum": 4936.0, "discounted_cash": 1496.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGNATURE APATCH, PER SQ CM", "code_information": [{"code": "Q4260", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "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": 6009.88, "maximum": 13793.91, "discounted_cash": 11818.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9104.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9104.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13793.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12085.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7962.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6797.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6009.88, "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": 3085.59, "maximum": 6261.7, "discounted_cash": 7426.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4132.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4132.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6261.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5486.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3614.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3085.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3644.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4366.22, "maximum": 8860.53, "discounted_cash": 11350.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5848.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5848.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8860.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7763.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5114.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4366.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5740.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3077.45, "maximum": 6245.18, "discounted_cash": 7157.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4121.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4121.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6245.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5471.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3605.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3077.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3545.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SILICONE BULB EVACUATOR KITS 0071440", "code_information": [{"code": "71440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE FOLEY URINE METER 16FR10ML DYND160816", "code_information": [{"code": "DYND160816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER NITRATE APPLICATORS", "code_information": [{"code": "MED0184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER SULFADIAZINE CREAM/SILVADENE", "code_information": [{"code": "MED0185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 30ML DROPS MYLOCON", "code_information": [{"code": "MED0186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE CYSTOMETROGRAM", "code_information": [{"code": "51725", "type": "CPT"}], "standard_charges": [{"minimum": 159.87, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3659.66, "maximum": 8431.06, "discounted_cash": 7205.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5564.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5564.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8431.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7386.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4866.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4154.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3659.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5880.9, "maximum": 15241.98, "discounted_cash": 11752.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10059.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10059.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15241.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13354.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8798.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7510.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5880.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2779.11, "maximum": 5920.33, "discounted_cash": 5619.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3907.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3907.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5920.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5187.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3417.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2917.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2779.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.48, "maximum": 37.48, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.48, "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": 17460.15, "maximum": 53851.43, "discounted_cash": 35948.74, "estimated_discounted_cash": 82651.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35542.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35542.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53851.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47181.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31086.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26536.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17460.15, "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": 22984.9, "maximum": 70891.13, "discounted_cash": 47653.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46788.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46788.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 70891.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62110.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 40922.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 34933.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22984.9, "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": 13772.82, "maximum": 42478.79, "discounted_cash": 28884.17, "estimated_discounted_cash": 62047.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28036.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28036.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42478.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37217.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24521.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20932.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13772.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3899.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "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": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE MONOPOLAR STIMULATING PROBE 2701-90026", "code_information": [{"code": "2701-90026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7845.9, "maximum": 15921.98, "discounted_cash": 19402.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10508.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10508.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15921.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13949.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9191.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7845.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10760.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4365.71, "maximum": 11842.03, "discounted_cash": 9078.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7815.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7815.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11842.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10375.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6835.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5835.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4365.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 156.82, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 158.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 158.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 170.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 158.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 156.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZE MEDIUM  STOCKING ANTI EMBOLISM  SHORT MDS160844", "code_information": [{"code": "MDS160844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SKEL MUSC RELAXANT 3 OR MORE", "code_information": [{"code": "80370", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKELETAL MUSCLE RELAXANT 1/2", "code_information": [{"code": "80369", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKI FOR WALKER MDS86615SKI", "code_information": [{"code": "MDS86615SKI", "type": "CDM"}], "standard_charges": [{"gross_charge": 17.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN AND MUSCLE REPAIR FACE", "code_information": [{"code": "15845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1283.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7472.4, "maximum": 21235.27, "discounted_cash": 15106.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14015.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14015.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21235.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18604.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12258.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10464.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7472.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [{"code": "570", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13434.52, "maximum": 34629.99, "discounted_cash": 26297.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22856.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22856.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34629.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30340.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19990.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 17064.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13434.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITHOUT CC/MCC", "code_information": [{"code": "572", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5098.53, "maximum": 13588.81, "discounted_cash": 10249.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8968.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8968.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13588.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11905.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7844.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6696.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5098.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN FUNGI CULTURE", "code_information": [{"code": "87101", "type": "CPT"}], "standard_charges": [{"minimum": 6.94, "maximum": 584.01, "discounted_cash": 10.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.94, "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": 11884.08, "maximum": 25871.32, "discounted_cash": 23700.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17075.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17075.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25871.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22666.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14934.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12748.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11884.08, "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": 16798.78, "maximum": 34090.4, "discounted_cash": 43823.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 22499.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 22499.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 34090.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29867.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19679.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16798.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24079.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6323.79, "maximum": 12833.11, "discounted_cash": 14363.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8469.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8469.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12833.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11243.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7408.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6323.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7544.26, "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": 10500.76, "maximum": 21309.6, "discounted_cash": 31039.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14064.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14064.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21309.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18670.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12301.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10500.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 15463.85, "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": 27484.05, "maximum": 62729.86, "discounted_cash": 58578.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41402.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41402.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62729.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 54959.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36211.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 30911.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 27484.05, "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": 8721.58, "maximum": 17699.04, "discounted_cash": 16067.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11681.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11681.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17699.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15506.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10216.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8721.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8911.27, "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": 8536.83, "maximum": 23433.54, "discounted_cash": 16039.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15466.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15466.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23433.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20530.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13527.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 11547.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8536.83, "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": 16700.55, "maximum": 74716.42, "discounted_cash": 31824.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49313.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49313.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 74716.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 65461.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 43130.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 36818.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 16700.55, "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": 4476.84, "maximum": 22101.08, "discounted_cash": 11193.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14586.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14586.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22101.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19363.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12758.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10890.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4476.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14529.19, "maximum": 29484.63, "discounted_cash": 32842.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19460.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19460.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29484.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25832.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17020.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14529.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 17232.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7355.92, "maximum": 15532.43, "discounted_cash": 13263.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10251.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10251.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15532.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13608.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8966.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7653.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7355.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP ARMS/LEGS", "code_information": [{"code": "15572", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1236.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP TRUNK", "code_information": [{"code": "15570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1294.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 162.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"minimum": 264.55, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 264.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT TRNK/ARM/LEG", "code_information": [{"code": "15100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1217.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB FDA CLRD AS DEV NOS", "code_information": [{"code": "A4100", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [{"code": "15276", "type": "CPT"}], "standard_charges": [{"minimum": 45.11, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT FACE/NK/HF/G", "code_information": [{"code": "15275", "type": "CPT"}], "standard_charges": [{"minimum": 214.37, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 283.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 283.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 305.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 283.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 214.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 34.22, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 53.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT TRNK/ARM/LEG", "code_information": [{"code": "15271", "type": "CPT"}], "standard_charges": [{"minimum": 209.72, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 261.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 261.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 261.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 209.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"minimum": 425.89, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 590.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 425.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TE 1 SQ CM", "code_information": [{"code": "Q4200", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 18.09, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 5.9, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4615.83, "maximum": 9367.08, "discounted_cash": 10607.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6182.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6182.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9367.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8206.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5407.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4615.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5456.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7192.69, "maximum": 14596.41, "discounted_cash": 17304.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9633.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9633.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14596.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12788.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8425.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7192.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9177.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3787.75, "maximum": 8864.66, "discounted_cash": 7750.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5850.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5850.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8864.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7766.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5117.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4368.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3787.75, "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": 290.85, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 290.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT FAC/NCK/HF/G", "code_information": [{"code": "15120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1159.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "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": 133.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 166.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 133.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 478.08, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 588.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 588.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 635.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 588.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 478.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 114.21, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 128.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 128.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 138.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 128.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 114.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3049.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5327.24, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5327.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 501.95, "maximum": 1858.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 739.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 739.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 798.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 739.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1858.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATT&RESP EFFT", "code_information": [{"code": "95806", "type": "CPT"}], "standard_charges": [{"minimum": 76.25, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 213.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 450.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEVE COMPR SM THIGH LEN COMPRESSION SYS TUBING SCD EXPRESS LF", "code_information": [{"code": "9545 (Sleeve)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE COMPRESSION LG KNEE LGTH SCD 9789", "code_information": [{"code": "9789-", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE COMPRESSION MED KNEE LOWER LEG SCD 9529-", "code_information": [{"code": "9529-", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE EXPANDABLE RADIALLY VERSASTEP VS101000", "code_information": [{"code": "VS101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE GOWN 23IN BLUE SURG AURORA LF STRL", "code_information": [{"code": "DYNJP2000A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2845.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3696.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY 12MM DIAMETER 2B12LT", "code_information": [{"code": "2B12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 679.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 12MMX100MM CB12LT", "code_information": [{"code": "CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 5MMX100MM 2CB5LT", "code_information": [{"code": "2CB5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STABILITY TROCAR XCEL 5MMX100MM CB5LT", "code_information": [{"code": "CB5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STERILE", "code_information": [{"code": "599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TROCAR 5MM X 100MM UNIVERSAL STABILITY REPROCESS ENDOPATH XCEL", "code_information": [{"code": "CB5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM EXTRA SM 13IN X 6.5IN SPECIAL ENVELOPE THUMB LOOP PAD STRP DOUBLE", "code_information": [{"code": "79-84272", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM LG 19.5IN X 8IN SPECIAL ENVELOPE THUMB LOOP PAD STRP DOUBLE", "code_information": [{"code": "79-84277", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM MED 15IN X 8IN THUMB LOOP SHOULDER PAD WEB STRP COTTON POLYESTER", "code_information": [{"code": "SDJ7984005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM MED 17IN X 7.5IN SPECIAL ENVELOPE THUMB LOOP PAD STRP DOUBLE", "code_information": [{"code": "79-84275", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM MED BLUE UNISEX HOOK AND LOOP CLOSURE COTTON POLYESTER PROCARE", "code_information": [{"code": "79-84005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM SM 16IN SPECIAL ENVELOPE THUMB LOOP D RING PAD STRP DOUBLE", "code_information": [{"code": "79-84273", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING ARM XL DME", "code_information": [{"code": "79-84278", "type": "CDM"}], "standard_charges": [{"gross_charge": 18.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING II AND ABDUCTION PILLOW MEDI", "code_information": [{"code": "8503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"minimum": 222.99, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}], "standard_charges": [{"minimum": 271.79, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CH", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337935", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CI", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337936", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CJ", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337937", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CK", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337938", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CL", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337939", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CM", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337940", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN CURRENT  G9165 CN", "code_information": [{"code": "G9165", "type": "HCPCS"}, {"code": "45337941", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CH", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337980", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CI", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337981", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CJ", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337982", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CK", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337983", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CL", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337984", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CM", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337986", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN DC  G9167 CN", "code_information": [{"code": "G9167", "type": "HCPCS"}, {"code": "45337987", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CH", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337988", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CI", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337989", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CJ", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337990", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CK", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337991", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CL", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337992", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CM", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337993", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP ATTEN GOAL  G9166 CN", "code_information": [{"code": "G9166", "type": "HCPCS"}, {"code": "45337994", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CH", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45337995", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CI", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45337996", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CJ", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45337997", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CK", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45337998", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CL", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45337999", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CM", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45338000", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP CURRENT  G9159 CN", "code_information": [{"code": "G9159", "type": "HCPCS"}, {"code": "45338001", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CH", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338002", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CI", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338003", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CJ", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338004", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CK", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338005", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CL", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338006", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CM", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338007", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP DC  G9161 CN", "code_information": [{"code": "G9161", "type": "HCPCS"}, {"code": "45338008", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CH", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338009", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CI", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338010", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CJ", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338011", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CK", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338012", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CL", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338013", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CM", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338014", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG COMP GOAL  G9160 CN", "code_information": [{"code": "G9160", "type": "HCPCS"}, {"code": "45338015", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CH", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": "45338016", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CI", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": "45338017", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CJ", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": "45338018", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CK", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": "45338019", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CL", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": "45338020", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP LANG EXPRES DC  G9164 CM", "code_information": [{"code": "G9164", "type": "HCPCS"}, {"code": 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"standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SPEECH LANG GOAL  G9175 CN", "code_information": [{"code": "G9175", "type": "HCPCS"}, {"code": "45338099", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 81.95, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 450.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATTENDED", "code_information": [{"code": "95800", "type": "CPT"}], "standard_charges": [{"minimum": 134.05, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 245.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 227.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 450.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CH", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338100", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CI", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338101", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CJ", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338102", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CK", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338103", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CL", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338104", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CM", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338105", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW CURRENT  G8996 CN", "code_information": [{"code": "G8996", "type": "HCPCS"}, {"code": "45338106", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CH", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338107", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CI", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338108", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CJ", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338109", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CK", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338110", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CL", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338111", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CM", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338112", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW DC  G8998 CN", "code_information": [{"code": "G8998", "type": "HCPCS"}, {"code": "45338113", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CH", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338114", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CI", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338115", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CJ", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338116", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CK", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338117", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CL", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338118", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CM", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338119", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP SWALLOW GOAL  G8997 CN", "code_information": [{"code": "G8997", "type": "HCPCS"}, {"code": "45338120", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CH", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338121", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CI", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338122", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CJ", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338123", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CK", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338124", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CL", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338125", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CM", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338126", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE CURRENT  G9171 CN", "code_information": [{"code": "G9171", "type": "HCPCS"}, {"code": "45338127", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CH", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338128", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CI", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338129", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CJ", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338130", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CK", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338131", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CL", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338132", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CM", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338133", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE DC  G9173 CN", "code_information": [{"code": "G9173", "type": "HCPCS"}, {"code": "45338134", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CH", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338135", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CI", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338136", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CJ", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338137", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CK", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338138", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CL", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338139", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CM", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338140", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SLP VOICE GOAL  G9172 CN", "code_information": [{"code": "G9172", "type": "HCPCS"}, {"code": "45338141", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 15.16, "maximum": 584.01, "discounted_cash": 21.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44360", "type": "CPT"}], "standard_charges": [{"minimum": 173.24, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 230.11, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 244.95, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 244.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 218.48, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 286.12, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 293.25, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 293.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44372", "type": "CPT"}], "standard_charges": [{"minimum": 286.53, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 230.09, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 338.06, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 338.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 455.48, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 455.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 441.79, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 441.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44384", "type": "CPT"}], "standard_charges": [{"minimum": 182.61, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 182.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44380", "type": "CPT"}], "standard_charges": [{"minimum": 295.45, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 295.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1403.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44361", "type": "CPT"}], "standard_charges": [{"minimum": 190.95, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 190.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44377", "type": "CPT"}], "standard_charges": [{"minimum": 354.5, "maximum": 4936.0, "discounted_cash": 2399.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 354.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 319.91, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 319.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALLPOX&MONKEYPOX VAC 0.5ML", "code_information": [{"code": "90611", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMARTGOWN BREATH IMPERV LARGE 89015", "code_information": [{"code": "89015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SMARTGOWN LARGE NO RETURN 39015", "code_information": [{"code": "39015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SMARTGOWN, X-LARGE", "code_information": [{"code": "89045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SMEAR COMPLEX STAIN", "code_information": [{"code": "87209", "type": "CPT"}], "standard_charges": [{"minimum": 16.18, "maximum": 584.01, "discounted_cash": 23.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 35.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.18, 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 19.51, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 844.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE 5 TRAY 12PK 8801075", "code_information": [{"code": "8801075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIN NDL 27G TW 5 WHITACRE PNCL PNT 405144", "code_information": [{"code": "405144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95990", "type": "CPT"}], "standard_charges": [{"minimum": 127.82, "maximum": 1270.0, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 165.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 165.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 165.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95991", "type": "CPT"}], "standard_charges": [{"minimum": 153.95, "maximum": 1270.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 223.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 223.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 241.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 223.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 153.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "52", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8981.79, "maximum": 27574.05, "discounted_cash": 16195.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18199.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18199.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27574.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24158.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15917.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13587.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8981.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC", "code_information": [{"code": "53", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4112.21, "maximum": 12107.69, "discounted_cash": 8755.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7991.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7991.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12107.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10607.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6989.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5966.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4112.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [{"code": "457", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25614.94, "maximum": 106677.37, "discounted_cash": 53318.23, "estimated_discounted_cash": 100051.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 70407.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 70407.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106677.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 93463.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 61580.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 52567.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 25614.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [{"code": "456", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37798.04, "maximum": 170190.46, "discounted_cash": 75137.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112326.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112326.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 170190.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 149109.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 98244.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 83865.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 37798.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT 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"BLUECARE TENNCARE SELECT", "standard_charge_dollar": 44075.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 19271.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "29", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14980.95, "maximum": 41947.46, "discounted_cash": 30504.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27685.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27685.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41947.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36751.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24214.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 20670.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 14980.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "28", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21011.02, "maximum": 42638.46, "discounted_cash": 53722.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28141.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28141.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 42638.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37357.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24613.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21011.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 27132.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "30", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9931.96, "maximum": 25293.19, "discounted_cash": 19628.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16693.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16693.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25293.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 22160.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14600.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 12463.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9931.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"minimum": 237.56, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 237.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRMTRY W/BRNCHDIL INF-2 YR", "code_information": [{"code": "94012", "type": "CPT"}], "standard_charges": [{"minimum": 162.82, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 308.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 308.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 333.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 308.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 162.82, "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": 94.75, "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": 11.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE AIRLIFE AIRX BALL TYPE LATEX FRE 001901", "code_information": [{"code": "1900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE VOLUME 2500ML 001904A", "code_information": [{"code": "1904A", "type": "CDM"}], "standard_charges": [{"gross_charge": 12.39, "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": 12.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER VOLDYNE INCENTIVE 2500ML HUD8884719011", "code_information": [{"code": "HUD8884719011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.51, "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": 12.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 100.54, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 197.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 197.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 213.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 197.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 181.42, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 254.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13004.29, "maximum": 38014.8, "discounted_cash": 25119.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25090.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25090.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38014.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33306.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21944.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18732.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13004.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21220.67, "maximum": 54389.64, "discounted_cash": 40494.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35897.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35897.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 54389.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 47652.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31397.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 26801.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 21220.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7326.91, "maximum": 32006.38, "discounted_cash": 17068.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21124.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21124.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32006.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28041.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18476.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15771.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7326.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2785.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE 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PRODUCTS", "code_information": [{"code": "86985", "type": "CPT"}], "standard_charges": [{"minimum": 21.71, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLITTER PILL BLUE  144 CT", "code_information": [{"code": "NON135000CT", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE ABS 8X6.25CM HMSTC AGNT GELTN SRGFM THK10MM STRL LF 1973", "code_information": [{"code": "1973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE BOWL 32 0Z  STERILE SSK9002A", "code_information": [{"code": "SSK9002A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DISSECT 3/8IN PEANUT SHAPED FOAM HOLDER XRAY DETECT ELEMENT LF STRL", "code_information": [{"code": "30-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DISSECTING 9/16IN X 14IN WHT KITTNER BLUNT CYLINDRICAL SHAPE X RAY DETECT", "code_information": [{"code": "30-101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DISSECTOR 9/16' X 1/4' MDS73512Z", "code_information": [{"code": "MDS73512Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE DISSECTOR KITTNER LATEX FREE 100% COTTON TIP STERILE DISPOSABLE 5MM", "code_information": [{"code": "28-0801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 12 PLY NON STRL LF", "code_information": [{"code": "NON25412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 12 PLY WOVEN COTTON LF STRL", "code_information": [{"code": "NON21426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 16 PLY COTTON ACCUSORB STRL", "code_information": [{"code": "NON21428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE 4IN X 4IN 16 PLY X RAY DETECT LF STRL", "code_information": [{"code": "NON21430LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GAUZE WOVEN SUPER FLUFF 6X6.75", "code_information": [{"code": "C-SUS665S", "type": "CDM"}], "standard_charges": [{"gross_charge": 21.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GELATIN SURGIFOAM 8CMX12.5CMX2MM 1975", "code_information": [{"code": "1975", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GELFOAM SZ 50", "code_information": [{"code": "P9032301P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GLTIN SURGIFM 8CMX12.5CMX10MM 1974", "code_information": [{"code": "1974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GUAZE WOVEN 4X4 12 PLY NS C-NSG4412E", "code_information": [{"code": "C-NSG4412E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAP 18 X 18IN COTTON X-RAY DETECTABLE UNWASHED NS", "code_information": [{"code": "23250-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAP 18IN X 18IN LAPAROTOMY XRAY DETECT COTTON W/ LOOP LF STRL", "code_information": [{"code": "MDS251518LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAPAROTOMY 18IN X 18IN X RAY DETECT COTTON WITHOUT RING STRL", "code_information": [{"code": "23250-400A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO 1 2X6 10 PK 30-301", "code_information": [{"code": "30-301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO 1/4INX 6IN", "code_information": [{"code": "30-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTON 09 NEUROSPNG09", "code_information": [{"code": "NEUROSPNG09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO COTTONOID 0.5IN X 0.5IN NEUROSPNG05", "code_information": [{"code": "NEUROSPNG05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.17, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE NEURO STERILE 1/4\" X 6\" STRIPS QTX30300", "code_information": [{"code": "QTX30300", "type": "CDM"}], "standard_charges": [{"gross_charge": 39.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE PATTIE .5IN X .5IN SURG COTTON STRL", "code_information": [{"code": "CO 801400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SUPER FLUFF 6IN X 6.75IN", "code_information": [{"code": "C-SUS662S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE SURG 4IN X 4IN WHT SIXTEEN PLY X-RAY DETECT RADIOPAQUE VISTEC STRL", "code_information": [{"code": "7317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS STUDY", "code_information": [{"code": "92531", "type": "CPT"}], "standard_charges": [{"minimum": 29.44, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"minimum": 5.51, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC", "code_information": [{"code": "537", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4101.5, "maximum": 10215.01, "discounted_cash": 8532.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6741.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6741.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10215.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8949.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5896.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5033.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4101.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC", "code_information": [{"code": "538", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2966.88, "maximum": 6020.81, "discounted_cash": 6440.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3973.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3973.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6020.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5275.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3475.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2966.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2996.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRAY CATHETERS Spray Catheter 133-5544   220 2.2", "code_information": [{"code": "SC62241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRAY CATHETERS Spray Catheter 133-5545   250 2.8", "code_information": [{"code": "SC62301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRAY DUAL 15.0MM X 15.0MM MINISPACER", "code_information": [{"code": "2092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRCHOROIDAL SPC NJX RX AGT", "code_information": [{"code": "67516", "type": "CPT"}], "standard_charges": [{"minimum": 163.31, "maximum": 4936.0, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 163.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUN MICROHEMATOCRIT", "code_information": [{"code": "85013", "type": "CPT"}], "standard_charges": [{"minimum": 4.36, "maximum": 584.01, "discounted_cash": 9.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPECIMEN COLLECTION", "code_information": [{"code": "89220", "type": "CPT"}], "standard_charges": [{"minimum": 20.67, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 347.18, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 347.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 251.67, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1696.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1285.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1369.51, "discounted_cash": 9208.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1266.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1266.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1369.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1266.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1266.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1231.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1748.88, "discounted_cash": 9208.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1617.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1617.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1748.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1617.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1617.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1411.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 290.23, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 290.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 584.01, "discounted_cash": 228.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 256.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 236.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAB PHLEB VEINS XTR 10-20", "code_information": [{"code": "37765", "type": "CPT"}], "standard_charges": [{"minimum": 544.31, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 544.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAGGERED SPONDAIC WORD TEST", "code_information": [{"code": "92572", "type": "CPT"}], "standard_charges": [{"minimum": 79.06, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 91.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 91.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 99.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 91.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 79.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPH A DNA AMP PROBE 87640", "code_information": [{"code": "87640", "type": "CPT"}, {"code": "46447975", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "gross_charge": 53.0, "discounted_cash": 45.62, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER 90 MM TA", "code_information": [{"code": "TL90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.93, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER CONTOUR CURVED CUTTER CS40G", "code_information": [{"code": "CS40G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1331.45, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER DISPOSABLE SURGICAL SKIN  STAPLER35WA", "code_information": [{"code": "STAPLER35WA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ECHELN FLEX POWERED VASC. W/ ADV PLACEMENT TIP", "code_information": [{"code": "PVE35A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.78, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 30MM GRN LINEAR CUTTER RELOAD TI", "code_information": [{"code": "ESXR30G", "type": "CDM"}], "standard_charges": [{"gross_charge": 138.16, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO 4MM X 4.8MM LINEAR CUTTER RELOADABLE", "code_information": [{"code": "ESTX30G", "type": "CDM"}], "standard_charges": [{"gross_charge": 287.79, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO GIA 4 XL EGIAUXL", "code_information": [{"code": "EGIAUXL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1420.41, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDO LNR CTR 45MM", "code_information": [{"code": "EC45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1039.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ENDOSCPC CRVD INTRALUM DIR O ECS33A", "code_information": [{"code": "ECS33A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 907.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN 35 COUNT WIDE STRL DISP", "code_information": [{"code": "528235", "type": "CDM"}], "standard_charges": [{"gross_charge": 43.22, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN FIXED HEAD 35 COUNT WIDE", "code_information": [{"code": "25-3001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.59, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER VASCULAR 30MM RELOAD PROXIMATE TI", "code_information": [{"code": "TX30V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 321.38, "setting": "both", "billing_class": "facility"}]}, {"description": "STAT LAB", "code_information": [{"code": "S3600", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAT LAB HOME/NF", "code_information": [{"code": "S3601", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEERABLE BALLOON CATHETER ARC15SB ARC15SB", "code_information": [{"code": "ARC15SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEERABLE BALLOON CATHETER ARC20SB", "code_information": [{"code": "ARC20SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ATTUNE EPAK PINNING SYSTEM 254400111", "code_information": [{"code": "2544-00-111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 806.38, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM CELLS TOTAL COUNT", "code_information": [{"code": "86367", "type": "CPT"}], "standard_charges": [{"minimum": 69.47, "maximum": 584.01, "discounted_cash": 101.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 29.16, "maximum": 584.01, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 29.59, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 971.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1280.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1830.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.88, "maximum": 75.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 69.88, "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": 194.48, "maximum": 4936.0, "gross_charge": 1690.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 194.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "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": 264.71, "maximum": 4936.0, "gross_charge": 1690.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 582.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 100ML VIAL", "code_information": [{"code": "MED0191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.6, "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": 3.03, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 5ML", "code_information": [{"code": "MED0192", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.28, "setting": "both", "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 729.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL LATEX FREE TEMPERATURE SENSOR STERILE 18FR SM18400ES", "code_information": [{"code": "SM18400ES", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.34, "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": 325.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION OF SPINAL CORD", "code_information": [{"code": "63610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 692.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION PACING HEART", "code_information": [{"code": "93623", "type": "CPT"}], "standard_charges": [{"minimum": 485.64, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 485.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 485.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 524.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 485.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATOR MAINSTAY TUNNELER TUN1", "code_information": [{"code": "TUN1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE COMPRESSION 6IN X 25YD TUBULAR NON STRL", "code_information": [{"code": "50625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.97, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE DOUBLE PLY STANDARD 6 X 72", "code_information": [{"code": "9606-72", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE TUBULAR 12IN X 48IN IMPERVIOUS STRL", "code_information": [{"code": "NON22535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.89, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM EXTRA XL SHRT THIGH HIGH NYLON TED LF", "code_information": [{"code": "3183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.84, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LG LNG BLUE THIGH LEN TED", "code_information": [{"code": "3856", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4282.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM LONG REGULAR LARGE CALF WHITE THIGH LENGTH NYLON SPANDEX LATEX FREE", "code_information": [{"code": "MDS160864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.16, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM MED REG WHT KNEE LEN OPENINSPECTION TOE NYLON SPANDEX TED", "code_information": [{"code": "7115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.02, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM REG LG CALF WHT BELOW KNEE LEG LEN NYLON SPANDEX LF", "code_information": [{"code": "MDS160664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.07, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM REG XL CALF WHT THIGH LEN NYLON SPANDEX LF", "code_information": [{"code": "MDS160884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.84, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM SM REG YELLOW KNEE LEN OPENINSPECTION TOE NYLON SPANDEX T", "code_information": [{"code": "7071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.12, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM XL LNG KNEE LEN CIRCULATION TED HOSE T.E.D LF", "code_information": [{"code": "7802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.12, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM XL REG GRN KNEE LEN OPENINSPECTION TOE NYLON SPANDEX TED", "code_information": [{"code": "7604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.02, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI EMBOLISM XL SHRT THIGH LEN TED HOSE", "code_information": [{"code": "3180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.14, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH MED REG LF", "code_information": [{"code": "MDS160644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.07, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH SMALL LONG LF", "code_information": [{"code": "MDS160628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.57, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH SMALL REG LF", "code_information": [{"code": "MDS160624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.57, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH XL REG LF", "code_information": [{"code": "MDS160684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.54, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM KNEE LENGTH XXL LONG LF", "code_information": [{"code": "MDS160698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM LG REG THIGH LEN DBM GRADUATED COMPRESSION", "code_information": [{"code": "3728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.13, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM MED WHT REG THIGH LENINSPECTOIN TOE NYLON SPANDEX T.E.D.", "code_information": [{"code": "3416LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM T-L XXL REG L", "code_information": [{"code": "MDS160894", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING ANTI-EMBOLISM TED THIGH LEN 3728LF", "code_information": [{"code": "3728LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.06, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING COMPRESSION ANTI EMBOLISM THIGH HIGH REGULAR MD", "code_information": [{"code": "23640-340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.77, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING COMPRESSION KNEE SML LONG ANTI EMBOLISM", "code_information": [{"code": "23640-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.77, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING EMS THIGH LENGTH ANTI-EMBOLISM", "code_information": [{"code": "MDS160824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.84, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING LIMB MED THIGH LEN ANTI EMBOLISM", "code_information": [{"code": "3416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.13, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED THIGH XXL REG LATEX FREE 3184LF", "code_information": [{"code": "3184LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.67, "setting": "both", "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10836.61, "maximum": 30058.63, "discounted_cash": 21854.47, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19838.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19838.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30058.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26335.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17351.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 14812.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 10836.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22667.58, "maximum": 66984.62, "discounted_cash": 44594.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44210.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44210.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 66984.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58687.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 38667.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 33008.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 22667.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7111.79, "maximum": 20062.49, "discounted_cash": 14326.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13241.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13241.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20062.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17577.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11581.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9886.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7111.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOOL CULTR AEROBIC BACT EA", "code_information": [{"code": "87046", "type": "CPT"}], "standard_charges": [{"minimum": 8.5, "maximum": 584.01, "discounted_cash": 12.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOPCOCK MEDICAL  456020", "code_information": [{"code": "456020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.83, "setting": "both", "billing_class": "facility"}]}, {"description": "STOPCOCK, 4-WAY, 45,PSI,HI-FLO DYNJSC401", "code_information": [{"code": "DYNJSC401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.09, "setting": "both", "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR REPROD TISSUE", "code_information": [{"code": "89344", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STPLER SKIN PROXIMATE PLUS MD REG 35 PMR35", "code_information": [{"code": "PMR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.83, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR RELOAD PRX TI THKTIS 55MM", "code_information": [{"code": "TRT55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.03, "setting": "both", "billing_class": "facility"}]}, {"description": "STPLR SKIN DISP ROTATING HEAD 35 REG PRR35", "code_information": [{"code": "PRR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 166.05, "maximum": 584.01, "discounted_cash": 396.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 179.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPECIMEN ANAL", "code_information": [{"code": "81265", "type": "CPT"}], "standard_charges": [{"minimum": 209.76, "maximum": 584.01, "discounted_cash": 302.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 428.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 396.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 209.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 209.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAIGHT TIP LIGHT", "code_information": [{"code": "2762-01-0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1415.62, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF ANKLE AND/OR FT", "code_information": [{"code": "29540", "type": "CPT"}], "standard_charges": [{"minimum": 37.91, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 42.64, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 99.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 99.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 107.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 99.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 42.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}], "standard_charges": [{"minimum": 38.96, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 102.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 95.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 94.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 94.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 101.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 94.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 47.02, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 89.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 89.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 89.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 39.14, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 94.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 94.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 102.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 94.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 39.14, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 107.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 26.09, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 58.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 58.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 62.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRATTICE TM", "code_information": [{"code": "Q4130", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A AG IA", "code_information": [{"code": "87430", "type": "CPT"}], "standard_charges": [{"minimum": 15.13, "maximum": 584.01, "discounted_cash": 21.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A ASSAY W/OPTIC", "code_information": [{"code": "87880", "type": "CPT"}], "standard_charges": [{"minimum": 14.88, "maximum": 584.01, "discounted_cash": 21.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA AMP PROBE", "code_information": [{"code": "87651", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA DIR PROBE", "code_information": [{"code": "87650", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], "standard_charges": [{"minimum": 37.58, "maximum": 584.01, "discounted_cash": 54.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 76.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 11.46, "maximum": 584.01, "discounted_cash": 16.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 11.39, "maximum": 584.01, "discounted_cash": 16.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 349.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 349.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 377.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 349.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 199.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE ONLY", "code_information": [{"code": "93350", "type": "CPT"}], "standard_charges": [{"minimum": 154.19, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 304.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 304.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 329.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 304.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 154.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN REINFORCD 1 2X4 R1547", "code_information": [{"code": "R1547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKIN REINFORCED 1 4X3 R1541", "code_information": [{"code": "R1541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKN REINFORCED 1 2X2 R1549", "code_information": [{"code": "R1549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP CLOSURE SKN REINFORCED 1 8X3 R1540", "code_information": [{"code": "R1540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPLINT 4IN X 15IN PRECUT 1-STEP MOLDABLE 3M SCOTCHCAST LF", "code_information": [{"code": "M76415A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.15, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPLINT 4INX 30IN PRECUT 1-STEP MOLDABLE 3M SCOTCHCAST", "code_information": [{"code": "M76430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.82, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPS SURGICAL COTTONOID 1/2 X 6 80-1451CS", "code_information": [{"code": "80-1451CS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.48, "setting": "both", "billing_class": "facility"}]}, {"description": "STRYKER EGG BURR MEDIUM 4.0MM", "code_information": [{"code": "5120-015-040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRYKER INTERPULSE HP SET W/BONE CLEAN TIP", "code_information": [{"code": "210-114-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET ALUMINUM COATED SIZE 14FR", "code_information": [{"code": "M0914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.87, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATING 14 FR 85865", "code_information": [{"code": "85865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATION 14FR LUBRICATED", "code_information": [{"code": "251014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.06, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLETINTUBATING 6FR", "code_information": [{"code": "85863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBRTA NJX RX AGT W/VTRC", "code_information": [{"code": "810T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 5201.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 131.45, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 833.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 651.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 794.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1081.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1808.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION CATH 14FR CONTROL COIL", "code_information": [{"code": "T60C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION FRAZIER SURGICAL INSTRUMENT WITH CONTROL VENT 12FR STER", "code_information": [{"code": "DC3312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY HEAD&NECK", "code_information": [{"code": "15876", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY LWR EXTREM", "code_information": [{"code": "15879", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY TRUNK", "code_information": [{"code": "15877", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY UPR EXTREM", "code_information": [{"code": "15878", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION PULSED LAVAGE IRR WOUND DEBRIDEMENT W/ SUCTION AND BONE CLEANIN", "code_information": [{"code": "210110000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 4.95, "maximum": 584.01, "discounted_cash": 7.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 14.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUAL", "code_information": [{"code": "84376", "type": "CPT"}], "standard_charges": [{"minimum": 4.95, "maximum": 584.01, "discounted_cash": 7.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUANT", "code_information": [{"code": "84378", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 14.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPLEMENTAL ELECTRICAL TEST", "code_information": [{"code": "92547", "type": "CPT"}], "standard_charges": [{"minimum": 10.66, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPORTER ATHLETIC 39 TO 44IN LG WHT SWIMMER NYLON AND ELASTIC 3M BAUER AND BLAC", "code_information": [{"code": "206972", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPRA SDRM, PER SQ CM", "code_information": [{"code": "A2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRATHEL, PER SQ CM", "code_information": [{"code": "A2012", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFAC TRNSPORT ADDL", "code_information": [{"code": "99486", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFACILTY TRANSPORT", "code_information": [{"code": "99485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN THRU TUBE", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"minimum": 66.3, "maximum": 584.01, "discounted_cash": 273.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 115.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 115.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 124.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 115.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG DX EXAM ANORECTAL", "code_information": [{"code": "45990", "type": "CPT"}], "standard_charges": [{"minimum": 131.91, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 131.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGALLOY V-LOC 3-0 0.5 CIRC. 12IN NON-ABSORB TPR", "code_information": [{"code": "VLOCN0614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 2962.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2743.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2743.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2962.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2743.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2144.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR LIVER LESION", "code_information": [{"code": "47300", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1403.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR URETHRA POUCH", "code_information": [{"code": "53240", "type": "CPT"}], "standard_charges": [{"minimum": 528.29, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 528.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR VULVA LESION", "code_information": [{"code": "56440", "type": "CPT"}], "standard_charges": [{"minimum": 218.29, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 218.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5046.26, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5046.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1423.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 827.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 906.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1121.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 653.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": 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"plan_name": "OSCAR", "standard_charge_dollar": 1062.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 6", "code_information": [{"code": "2D73DP60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 6 1/2", "code_information": [{"code": "2D73DP65", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 7 1/2", "code_information": [{"code": "2D73DP75", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 8", "code_information": [{"code": "2D73DP80", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 8 1/2", "code_information": [{"code": "2D73DP85", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GLOVES PROTEXIS NEOPRENE POWDER FREE SIZE 9", "code_information": [{"code": "2D73DP90", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL GOWN UNREINFORCED AAMI LEVEL 3 SMALL/MEDIUM STERILE", "code_information": [{"code": "9505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL LUBRICANT (SURGILUBE) 5 GRAM OINTMENT", "code_information": [{"code": "MED0193", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL MASK SECURE-GARD DUCKBILL ANTI-FOG FLUID RESISTANT 160MMHG MEDITERRANEAN BLUE", "code_information": [{"code": "AT54535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1669.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1353.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 981.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1179.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 927.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PLANITOTAL IDENTITY CR IVIEW  5560-12-5050", "code_information": [{"code": "5560-12-5050", "type": "CDM"}], "standard_charges": [{"gross_charge": 2100.0, "setting": "both", "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": 2929.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1655.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1855.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1315.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICEL 4X8 PACKET", "code_information": [{"code": "MED0194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL ABSORBABLE HEMOSTAT 2 X 4IN SNOW NONWOVEN STRL DISP", "code_information": [{"code": "2082 Surgicel", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL FIBRILLAR 1X2 PACKET", "code_information": [{"code": "MED0195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL SNOW ABS HEMOSTAT 2\" X 4\" 2082", "code_information": [{"code": "2082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICORD PER SQ CM", "code_information": [{"code": "Q4218", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGIFLO", "code_information": [{"code": "MED0196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM 8X12.5CMX10MM SPONGE", "code_information": [{"code": "MED0197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIGRAFT DUAL PER SQ CM", "code_information": [{"code": "Q4219", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGIGRAFT, 1 SQ CM", "code_information": [{"code": "Q4183", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGIPHOR STERILE WOUND IRRIGATION 214380", "code_information": [{"code": "214380", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 250.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIWAND II 5MM CAUT SPATULA TUB GFS 178094", "code_information": [{"code": "178094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 569.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGRAFT FT PER SQ CM", "code_information": [{"code": "Q4268", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT PER SQ CM", "code_information": [{"code": "Q4209", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT TL, PER SQ CM", "code_information": [{"code": "Q4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT XT PER SQ CM", "code_information": [{"code": "Q4269", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1220.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF BREAST", "code_information": [{"code": "19316", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 8302.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 964.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF TESTIS", "code_information": [{"code": "54620", "type": "CPT"}], "standard_charges": [{"minimum": 367.87, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58400", "type": "CPT"}], "standard_charges": [{"minimum": 555.33, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 555.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 961.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1146.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE  0 27 CHROMIC GUT SH G124H", "code_information": [{"code": "G124H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 27 PDS PLUS VIO MONO CT1 PDP340H", "code_information": [{"code": "PDP340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 27 PDS PLUS VIO MONO CT2 PDP334H", "code_information": [{"code": "PDP334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 27IN COATED VICRYL PLUS UND VCP267H", "code_information": [{"code": "VCP267H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 27IN COATED VICRYL PLUS UND VCP534H", "code_information": [{"code": "VCP534H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.99, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 36 PDS PLUS VIO MONO CT1 PDP346H", "code_information": [{"code": "PDP346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 36IN COATED VICRYL PLUS UND VCP946H", "code_information": [{"code": "VCP946H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 60 PDS PLUS VIO MONO CTX PDP990G", "code_information": [{"code": "PDP990G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27 PDS PLUS VIO MONO CP1 PDP468H", "code_information": [{"code": "PDP468H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27 PDS PLUS VIO MONO CT1 PDP341H", "code_information": [{"code": "PDP341H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27IN COATED VICRYL VIL CT2 VCP335H", "code_information": [{"code": "VCP335H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27IN COATED VICRYL VIL CTX VCP365H", "code_information": [{"code": "VCP365H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36 PDS PLUS VIO MONO CT1 PDP347H", "code_information": [{"code": "PDP347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36 PDS PLUS VIO MONO CTX PDP371T", "code_information": [{"code": "PDP371T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36IN COATED VICRYL UND CTX VCP977H", "code_information": [{"code": "VCP977H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 48 PDS PLUS VIO MONO TP1 PDP880G", "code_information": [{"code": "PDP880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 818 CTD VIC UND BR CTX JB725", "code_information": [{"code": "JB725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 818 CTD VIC VIO BR CTX J765D", "code_information": [{"code": "J765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 827IN COATED VICRYL UND CR CT VCPP40D", "code_information": [{"code": "VCPP40D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2 27IN COATED VICRYL UND CP VCP195H", "code_information": [{"code": "VCP195H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 CTD VIC VIO BR UR J375H", "code_information": [{"code": "J375H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS CLR MONO CT1 PDP259H", "code_information": [{"code": "PDP259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO CT1 PDP339H", "code_information": [{"code": "PDP339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.99, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO CT2 PDP333H", "code_information": [{"code": "PDP333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO SH PDP317H", "code_information": [{"code": "PDP317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  3/0 27 PDS PLUS VIO MONO CT1 PDP338H", "code_information": [{"code": "PDP338H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  5/0 30 PDS  VIO MONO RB1 D/A PDP320H", "code_information": [{"code": "PDP320H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  COATED VICRYL PLUS UND BR VCP603H", "code_information": [{"code": "VCP603H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  CTD VICRYL PLUS UND BR 36 VCP947H", "code_information": [{"code": "VCP947H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  UNDYED  BRAIDED  3.0  18 LONG J864D", "code_information": [{"code": "J864D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  UNDYED  BRAIDED  3.0  27 LONG J416H", "code_information": [{"code": "J416H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 18 COATED VICRYL PLS UND BR CR VCP724D", "code_information": [{"code": "VCP724D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT CT-1 812H", "code_information": [{"code": "812H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT MO-4 4924H", "code_information": [{"code": "4924H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CHROMIC GUT UR-5 U246H", "code_information": [{"code": "U246H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 COAT VICRYL PLS UND BR CT-2 VCP270H", "code_information": [{"code": "VCP270H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR CP-2 J870H", "code_information": [{"code": "J870H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR CT-2 J270H", "code_information": [{"code": "J270H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR J260H", "code_information": [{"code": "J260H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC UND BR SH J418H", "code_information": [{"code": "J418H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CP-1 J467H", "code_information": [{"code": "J467H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CT-2 J334H", "code_information": [{"code": "J334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR CT3/F J329H", "code_information": [{"code": "J329H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-4 J381H", "code_information": [{"code": "J381H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-5 J376H", "code_information": [{"code": "J376H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 CTD VIC VIO BR UR-6 J603H", "code_information": [{"code": "J603H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 MONOCRYL VIO MONO CT Y340H", "code_information": [{"code": "Y340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 MONOCRYL VIO MONO UR Y606H", "code_information": [{"code": "Y606H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 27 PDS II VIO MONO CT-1 Z340H", "code_information": [{"code": "Z340H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0 3-18 CTD VIC UND BR OS- J749T", "code_information": 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"type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 27 MONOCRYL UND MONO Y213H", "code_information": [{"code": "Y213H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 27 MONOCRYL VIO MONO Y303H", "code_information": [{"code": "Y303H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 30 PDS II VIO MONO C- Z126H", "code_information": [{"code": "Z126H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5/0 30 PDS II VIO MONO RB Z148H", "code_information": [{"code": "Z148H", "type": "CDM"}, {"code": "272", "type": 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"setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CHROMIC GUT PS-4 1641G", "code_information": [{"code": "1641G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC UND BR P-1 J489G", "code_information": [{"code": "J489G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC UND BR P-3 J492G", "code_information": [{"code": "J492G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 6/0 18 CTD VIC VIO BR S-1 J570G", "code_information": [{"code": "J570G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.75, "setting": "both", "billing_class": 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"CX45D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 3-0 UR-6", "code_information": [{"code": "N877H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 7-0 18IN ABSORBL MONO", "code_information": [{"code": "1797G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 0 18IN UNDYED SNGL ARM SNGL PK CONTROL RELEASE W/ CT-1 NDL", "code_information": [{"code": "CC41G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 0 27IN UNDYED CT-2 NDL SNGL ARM SNGL PK ABSORB SURG GUT STRL", 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"1635G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT 6-0 18IN CLR UNDYED PS-6 NDL SNGL ARM SNGL PK ABSORB SURG GUT", "code_information": [{"code": "1816G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATD VICRYL+ 4-0 PS-2 27 UNDYED VCP426H", "code_information": [{"code": "VCP426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL + ANTIBAC UND BR 1 VCP371H", "code_information": [{"code": "VCP371H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COATED VICRYL PLUS  1 118 VIL B 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{"description": "SUTURE ENDOSTITCH SURGIDAC GRN O 48 170043", "code_information": [{"code": "170043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SZ 0 7IN GRN COATED BRAIDED ES9 NDL", "code_information": [{"code": "173026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ENDOSTITCH SZ 2/0 7 NDL", "code_information": [{"code": "170051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETH 3-0 KS 30IN MFL BLK NABS", "code_information": [{"code": "627H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 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"standard_charges": [{"gross_charge": 16.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 3-0 GRN BRAIDED EXCEL", "code_information": [{"code": "X622H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 4-0 30IN BLACK DYED KS NDL SNGL ARM SNGL PK NON ABSORBL MONO NYL", "code_information": [{"code": "626H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 5 30IN GRN DOUBLE ARM SNGL PK BRAIDED POLY W/ LR NDL", "code_information": [{"code": "B499T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND EXCEL 0 30IN GRN OS-4 NDL SNGL ARM BRAIDED POLYESTER", "code_information": 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"RC"}], "standard_charges": [{"gross_charge": 15.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 3/0 30 PSL 1691H", "code_information": [{"code": "1691H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 4/0 18 FS-1 1629H", "code_information": [{"code": "1629H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLACK 6/0 18 PC-3 1966G", "code_information": [{"code": "1966G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLCK 7/0 18 P-1 1696G", "code_information": [{"code": "1696G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLCK 7/0 18 P-6 1647G", "code_information": [{"code": "1647G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 0 48 CT L886T", "code_information": [{"code": "L886T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 10/0 12 CS160-6 9000G", "code_information": [{"code": "9000G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 10/0 6 CS160-6 9001G", "code_information": [{"code": "9001G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 2/0 18 FS 664G", "code_information": [{"code": "664G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 2/0 18 FS 664H", "code_information": [{"code": "664H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 5/0 18 S-14 7731G", "code_information": [{"code": "7731G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 8/0 5 BV130 2808G", "code_information": [{"code": "2808G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 8/0 5 BV130 2815G", "code_information": [{"code": "2815G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 12 TG140-8 7717G", "code_information": [{"code": "7717G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV100-4 2829G", "code_information": [{"code": "2829G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-3 2819G", "code_information": [{"code": "2819G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-4 2813G", "code_information": [{"code": "2813G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO BLK 9/0 5 BV130-5 2809G", "code_information": [{"code": "2809G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 4/0 18 P-3 691G", "code_information": [{"code": "691G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 4/0 18 PS-2 1611G", "code_information": [{"code": "1611G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON MONO UNDYED 5/0 18 P-3 690G", "code_information": [{"code": "690G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.17, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON SZ 5-0 18IN BLACK PC 1 CONVENTIONAL CUTTING PLIABILIZED NYLON", "code_information": [{"code": "1955G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON SZ 9 TO 0 10IN BLACK TAPER POINT NON ABSORBL MONO", "code_information": [{"code": "2800G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIPACK SZ 4-0 18IN PRE CUT MONO TIE NABS NON STRL", "code_information": [{"code": "DS32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHLN MNO BLK 8/0 12 TG175-8 1716G", "code_information": [{"code": "1716G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHYLON 6-0 PC I", "code_information": [{"code": "1856G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN NUMBER 2 BLUE ULTRA HIGH MOLECULAR WT POLYETHYLENE STRL", "code_information": [{"code": "AR-7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE 38IN SZ 2 BLUE T8 1/2 CIRC ULTRA HIGH MOLECULAR WT POLYETHYLENE", "code_information": [{"code": "AR-7206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GUT SZ 3-0 27IN UNDYED SNGL ARM SNGL PK TAPER POINT PLAIN GUT W/ CT-3 NDL", "code_information": [{"code": "N862H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding 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"setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L114G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 2-0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L113G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 3-0 54IN UNDYED LIGA REEL CHROMIC GUT", "code_information": [{"code": "L112G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LIGAPAK SZ 4-0 144IN BLACK LIGA REEL BRAIDED SILK", "code_information": [{"code": "LA53G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MAXBRAID 2 MO-6-NDL 2PACK BK/BL PLUS BL CM-0222N", "code_information": [{"code": "CM-0222N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MAXON 1 5X18 GRN T-12/GS-21 DTACH 8886627573", "code_information": [{"code": "8886627573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.83, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 12IN 5MM X 30MM WHT MO-4 TAPERED NDL HALF CIRC NON ABSORBL WOVEN", "code_information": [{"code": "RS23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS 4-0 18IN WHT DYED S-2 NDL DOUBLE ARM SNGL PK NON ABSORBL BRAIDED POL", 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{"description": "SUTURE MERSILENE GRN 0 30 CT-1 R424H", "code_information": [{"code": "R424H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 0 8-18 CT-1 MR21T", "code_information": [{"code": "MR21T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 1 30 LR R495T", "code_information": [{"code": "R495T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 2/0 30 SH R833H", "code_information": [{"code": "R833H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE GRN 3/0 30 SH R832H", "code_information": [{"code": "R832H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHITE 5/0 18 S-14 1760G", "code_information": [{"code": "1760G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 2 0 18 FS R665H", "code_information": [{"code": "R665H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 3 0 18 FS-1 R647H", "code_information": [{"code": "R647H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT 4 0 18 P-3 R691G", "code_information": [{"code": "R691G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE WHT WOVEN 5MM 12 BP-1 RS21", "code_information": [{"code": "RS21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 0 27IN VIOLET CT-2 NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y334H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 2-0 18IN VIOLET STERNAL ABSORBL MONO", "code_information": [{"code": "Y739D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 27 4-0 3/8 CIRCLE Y426H", "code_information": [{"code": "Y426H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 574.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 18IN PS-2 NDL SNGL ARM MONO ABSORB SYNTH", "code_information": [{"code": "Y497G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 27IN KS NDL SNGL ARM MONO SYNTH", "code_information": [{"code": "Y523H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0 27IN UNDYED PS-1NDL SNGL ARM MONO ABSORB SYNTH Y936H", "code_information": [{"code": "Y936H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 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"8735H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE QUILL PDO 2 VIOLET 36 X 36 W/CTX TAPER 48MM 1/2 CIRC DBL ARM RA-1065Q", "code_information": [{"code": "RA-1065Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE QUILL SZ 1 T9 NDL POLYDIOXANONE", "code_information": [{"code": "RA-1031Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 2-0 36IN UNDYED CT-1 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 3-0 18IN UNDYED PS-2 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 4-0 18IN UNDYED PC-3 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RAPIDE 4-0 18IN UNDYED PS-2 NDL SNGL ARM BRAIDED ABSORBL VICRYL SYNTH", "code_information": [{"code": "VR496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RELOAD PERMANENT W/VLOC 2-0 6 VLOCN206L", "code_information": [{"code": "VLOCN206L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 1 18IN DYED BLACK LIAGTURE TIES PRE CUT SIX STRAND BRAIDED SUTUPAK", "code_information": [{"code": "A187H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 2-0 PSLX", "code_information": [{"code": "591H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 5-0 30IN PERMA-HAND BRAIDED SUTUPAK PRECUT TIE LABYRINTH 12 STRAND BLACK", "code_information": [{"code": "A302H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 7-0 G6 18IN BRAIDED MICROPOINT REV CUT DBL ARM BLACK", "code_information": [{"code": "768G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK BLACK 1 30 BR MH K845H", "code_information": [{"code": "K845H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK C-1 6-0 30IN", "code_information": [{"code": "K889H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK PERMA-HAND 1 SUTUPAK 10-30IN BRAIDED BLACK", "code_information": [{"code": "SA87G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 2-0 20IN BLACK DYED CT-3 NDL SNGL ARM SNGL PK NON ABSORBL BRAIDED ANO", "code_information": [{"code": "413H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 3-0 18IN BLACK SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BRIADE", "code_information": [{"code": "C053D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 4-0 18IN TF BLACK SNGL ARM MULTI PK CONTROL RELEASE EIGHT STRANDS BRAIDE", "code_information": [{"code": "C084D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 5-0 18IN DYED BLACK LIGA TIES PRE CUT LENS TWELVE STRANDS BRAIDED SUT", "code_information": [{"code": "A182H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK 6-0 18IN BLACK DYED P-3 NDL SNGL ARM SNGL PK BRAIDED NON ABSORBL ANOR", "code_information": [{"code": "1639G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SLK PRMHND 2-0 MH 24IN BRAID BLK NABS", "code_information": [{"code": "M72T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4820.5, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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SPIRAL SZ1 MO-4 36X36CM PDO TAPER POINT DBL ARM VIOLET", "code_information": [{"code": "SXPD2B400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SUTURE 1-0 STRATAFIX SPIRAL PDS PLUS 36 X 36 CM DYED CT X SXPP2B405", "code_information": [{"code": "SXPP2B405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SYMM PDS PLUS 1 CTX 24 SXPP1A445", "code_information": [{"code": "SXPP1A445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX SZ1 CT 8IN SYMMETRIC PDS PLUS VIOLET", "code_information": [{"code": "SXPP1A405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX 4-0 FS-1 DBL ARMED", "code_information": [{"code": "SXMD2B150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX CT-1 2-0 UNDYED", "code_information": [{"code": "SXPD1B400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX PS-2 4-0 UNDYED", "code_information": [{"code": "SXPD1B101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SURGILON 4-0 CV-22 18IN NYLON BRAIDED TAPER POINT DTACH BLACK", "code_information": [{"code": "8886195732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 0 18IN CLR CHROMIC GUT LIGA TIES PRECUT 12 STRANDS", "code_information": [{"code": "SG14T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 4-0 18IN BLACK LIGA TIES PRE CUT BRAIDED TWELVE STRANDS SILK", "code_information": [{"code": "SA63H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK 4-0 24IN BLACK LIGA TIES PRE CUT BRAIDED SILK", "code_information": [{"code": "SA73H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUTUPAK SZ 0 18IN BLACK LIGA TIES PRE CUT BRAIDED 17 STRANDS SLK", "code_information": [{"code": "SA66G", 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"setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC SZ 3 TO 0 19MM CLR ABSORBL W/ WOUND CLOSURE DEV", "code_information": [{"code": "VLOCL0014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VLOC SZ 3 TO 0 6IN CLR ABSORBL POLYGLYCONATE P12 NDL", "code_information": [{"code": "VLOCL0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE: PRECISION POINT NONABSORBABLE NYLON SURGICAL MONOFILAMENT SUTURE BLACK 3/0 30\" PSLX NEEDLE 1", "code_information": [{"code": "1683H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 37.92, "discounted_cash": 54.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 37.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWAB AMPULES NOZASEPTIN POP BLISTERED SMKNNS1001", "code_information": [{"code": "SMKNNS1001", "type": "CDM"}], "standard_charges": [{"gross_charge": 13.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"minimum": 16.28, "maximum": 26.41, "discounted_cash": 23.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.41, "methodology": "fee 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"plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1120.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 926.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 976.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPHONY, PER SQ CM", "code_information": [{"code": "A2009", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": 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"standard_charge_dollar": 4057.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3463.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3888.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC SENTENCE TEST", "code_information": [{"code": "92576", "type": "CPT"}], "standard_charges": [{"minimum": 55.42, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 67.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 55.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TEST NON-TREP QUAL", "code_information": [{"code": "86592", "type": "CPT"}], "standard_charges": [{"minimum": 3.84, "maximum": 584.01, "discounted_cash": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TEST NON-TREP QUANT", "code_information": [{"code": "86593", "type": "CPT"}], "standard_charges": [{"minimum": 3.96, "maximum": 584.01, "discounted_cash": 5.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", 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"BCBS NETWORK EX", "standard_charge_dollar": 69.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 REVERSE", "code_information": [{"code": "84482", "type": "CPT"}], "standard_charges": [{"minimum": 14.18, "maximum": 584.01, "discounted_cash": 20.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAB IRRIGATION 1000ML", "code_information": [{"code": "MED0256", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 301.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 107.74, "maximum": 116.52, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAG, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4261", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2632.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2435.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALYMED", "code_information": [{"code": "Q4127", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMP 10/3 KIT 1ST FX INFL 1STP SURG BN KYPHN XPNDR 2 KPX103PB", "code_information": [{"code": "KPX103PB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11295.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 64.83, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 64.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"minimum": 126.94, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 533.68, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 533.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 197.37, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 197.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 326.22, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 326.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNIL BY INJECTION", "code_information": [{"code": "64486", "type": "CPT"}], "standard_charges": [{"minimum": 168.57, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAPE  MEDIPORE H 6IN X 10YD SOFT HYPOALLERGENIC CLOTH", "code_information": [{"code": "M2866S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE ADHSV SAFETY HALVE HIGHLY NOTICEABLE COUNTER MAG", "code_information": [{"code": "2241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 2IN X 4YD WHT WATER ACTIVATED FIBERGLASS SCOTCHCAST LF", "code_information": [{"code": "82002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CASTING 4IN X 4YD WHT LIGHTWEIGHT STRONG DURABLE SCOTCHCAST PLUS", "code_information": [{"code": "82004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CLOTH SURGICAL MEDIPORE-H 6X2YD 2866S", "code_information": [{"code": "2866S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE CURAD MEDICAL ADHESIVE3 X 10 YD NON270103", "code_information": [{"code": "NON270103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE DRESSING HYPAFIX 6IN X 2YD LF", "code_information": [{"code": "4217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE PINC ZINC OXIDE FIXATION 1/2IN X 5YD OMAM55CS", "code_information": [{"code": "OMAM55CS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE SURG 3IN X 10YD HYPOALLERGENIC ADHSV SILK 3M DURAPORE LF", "code_information": [{"code": "1538-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMB 1/18IN X 24IN WHT RADIOPAQUE COTTON LF STRL DISP", "code_information": [{"code": "U16G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 1/8IN X 18IN 2 STRANDS PER PACKET COTTON STRL", "code_information": [{"code": "U10T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 1/8X36 3 STRANDS U12T", "code_information": [{"code": "U12T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPE UMBILICAL 2-30 2 STRANDS U11T", "code_information": [{"code": "U11T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 852.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 90.0, "maximum": 584.01, "discounted_cash": 130.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 149.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB INTRADERMAL TEST", "code_information": [{"code": "86580", "type": "CPT"}], "standard_charges": [{"minimum": 9.37, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL IMMUN MEASURE", "code_information": [{"code": "86480", "type": "CPT"}], "standard_charges": [{"minimum": 55.78, "maximum": 584.01, "discounted_cash": 80.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 123.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 584.01, "discounted_cash": 178.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 13.37, "maximum": 21.7, "discounted_cash": 19.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 13.37, "maximum": 21.7, "discounted_cash": 19.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 52.45, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 52.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 13.83, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 34.84, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 3.76, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"minimum": 22.59, "maximum": 40.66, "discounted_cash": 32.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 22.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 22.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC VIS LIT HYPERSPECTRAL IMG", "code_information": [{"code": "631T", "type": "CPT"}], "standard_charges": [{"minimum": 33.3, "maximum": 36.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 33.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 33.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 376.9, "maximum": 4936.0, "discounted_cash": 35862.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 376.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 3219.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 551.54, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 551.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 152.4, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 152.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 2473.0, "maximum": 4936.0, "discounted_cash": 24082.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 587.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 401.38, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 520.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 520.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 562.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 520.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 401.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 324.13, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 501.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 501.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 501.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 324.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 430.16, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 430.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 430.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 464.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 430.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TD VACC NO PRESV 7 YRS+ IM", "code_information": [{"code": "90714", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TDAP VACCINE 7 YRS/> IM", "code_information": [{"code": "90715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAR FILM IMG UNI/BI W/I&R", "code_information": [{"code": "330T", "type": "CPT"}], "standard_charges": [{"minimum": 45.13, "maximum": 48.81, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT, MON", "code_information": [{"code": "C8927", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT,CONG", "code_information": [{"code": "C8926", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH INPT PHARM MGMT", "code_information": [{"code": "G0459", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.19, "maximum": 55.19, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 55.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN CPLX", "code_information": [{"code": "77307", "type": "CPT"}], "standard_charges": [{"minimum": 162.43, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 175.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 182.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}], "standard_charges": [{"minimum": 88.68, "maximum": 584.01, "discounted_cash": 468.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 88.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 88.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 95.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 88.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 88.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"minimum": 786.21, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 786.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"minimum": 1100.0, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2656.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPERATURE GRADIENT STUDIES", "code_information": [{"code": "93740", "type": "CPT"}], "standard_charges": [{"minimum": 16.44, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPORAL ARTERY PROCEDURE", "code_information": [{"code": "37609", "type": "CPT"}], "standard_charges": [{"minimum": 415.54, "maximum": 4936.0, "discounted_cash": 2065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 415.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPORARY EXTERNAL PACING", "code_information": [{"code": "92953", "type": "CPT"}], "standard_charges": [{"minimum": 1.18, "maximum": 2133.0, "discounted_cash": 826.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 23.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"minimum": 272.64, "maximum": 1270.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON EXCISION PALM/FINGER", "code_information": [{"code": "26145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 644.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON GRAFT FROM A DISTANCE 20924", "code_information": [{"code": "20924", "type": "CPT"}, {"code": "1582386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 622.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING", "code_information": [{"code": "26476", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 853.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON LNGTH UPR A/E EA TDN", "code_information": [{"code": "24305", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 716.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON SHORTENING", "code_information": [{"code": "26477", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 810.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSFER WITH GRAFT", "code_information": [{"code": "26492", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1188.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6916.31, "maximum": 14802.88, "discounted_cash": 13294.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9770.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9770.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14802.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12969.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8545.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7294.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6916.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3855.14, "maximum": 8596.24, "discounted_cash": 7986.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5673.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5673.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8596.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7531.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4962.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4235.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3855.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TDN AT ELBW", "code_information": [{"code": "24340", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 77.19, "maximum": 139.14, "discounted_cash": 148.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 128.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 128.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 128.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 128.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS", "code_information": [{"code": "24332", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 962.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENSIX, 1CM", "code_information": [{"code": "Q4146", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 584.01, "discounted_cash": 240.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 270.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 250.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FECES FOR TRYPSIN", "code_information": [{"code": "84488", "type": "CPT"}], "standard_charges": [{"minimum": 6.57, "maximum": 584.01, "discounted_cash": 9.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR ACETONE/KETONES", "code_information": [{"code": "82009", "type": "CPT"}], "standard_charges": [{"minimum": 4.07, "maximum": 584.01, "discounted_cash": 5.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR BLOOD FLOW IN GRAFT", "code_information": [{"code": "15860", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 123.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR CHLOROHYDROCARBONS", "code_information": [{"code": "82441", "type": "CPT"}], "standard_charges": [{"minimum": 5.41, "maximum": 584.01, "discounted_cash": 7.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 5.45, "maximum": 584.01, "discounted_cash": 7.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR PORPHOBILINOGEN", "code_information": [{"code": "84106", "type": "CPT"}], "standard_charges": [{"minimum": 5.24, "maximum": 584.01, "discounted_cash": 7.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 8.6, "maximum": 584.01, "discounted_cash": 12.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST PREG HCG QUICKVUE URINE CASS 20109", "code_information": [{"code": "20109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 8.77, "maximum": 584.01, "discounted_cash": 12.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST STRIP ACCU-CHEK INFORM II", "code_information": [{"code": "5942861001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST STRIP REVITAL OX 2BTL RESERT R60 SOLUTION", "code_information": [{"code": "PCC054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST URINE  HCG B1077-22", "code_information": [{"code": "B1077-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.48, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST URINE FOR LACTOSE", "code_information": [{"code": "83633", "type": "CPT"}], "standard_charges": [{"minimum": 10.13, "maximum": 584.01, "discounted_cash": 14.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR PORPHYRINS", "code_information": [{"code": "84119", "type": "CPT"}], "standard_charges": [{"minimum": 12.02, "maximum": 584.01, "discounted_cash": 17.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": 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"case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8527.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4773.62, "maximum": 9898.41, "discounted_cash": 9832.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6533.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6533.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9898.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8672.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5713.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4877.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4773.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTICULAR IMAGING W/FLOW", "code_information": [{"code": "78761", "type": "CPT"}], "standard_charges": [{"minimum": 205.5, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 216.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 216.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 233.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 216.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 216.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE BIOAVAILABLE", "code_information": [{"code": "84410", "type": "CPT"}], "standard_charges": [{"minimum": 46.15, "maximum": 584.01, "discounted_cash": 66.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE RESPONSE PANEL", "code_information": [{"code": "80414", "type": "CPT"}], "standard_charges": [{"minimum": 46.48, "maximum": 584.01, "discounted_cash": 67.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 95.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 102.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 95.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 95.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS ANTIBODY", "code_information": [{"code": "86774", "type": "CPT"}], "standard_charges": [{"minimum": 13.32, "maximum": 584.01, "discounted_cash": 19.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED OOCYTE", "code_information": [{"code": "89356", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED SPERM", "code_information": [{"code": "89353", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER FX NASAL INF TURBINATE", "code_information": [{"code": "30930", "type": "CPT"}], "standard_charges": [{"minimum": 145.11, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER INJECTION CARP TUNNEL", "code_information": [{"code": "20526", "type": "CPT"}], "standard_charges": [{"minimum": 116.57, "maximum": 4936.0, "discounted_cash": 383.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 31.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 46.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 46.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 50.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 46.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 29.69, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER NMA RDCTJ INTUS/OBSTRCJ", "code_information": [{"code": "74283", "type": "CPT"}], "standard_charges": [{"minimum": 129.67, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 129.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 129.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 140.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 129.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 232.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"minimum": 360.98, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 360.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR DRG CSF", "code_information": [{"code": "62272", "type": "CPT"}], "standard_charges": [{"minimum": 282.47, "maximum": 4936.0, "discounted_cash": 882.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 282.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/DIAG CONCURRENT INF", "code_information": [{"code": "96368", "type": "CPT"}], "standard_charges": [{"minimum": 27.72, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"minimum": 26.4, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG IV INF ADDON", "code_information": [{"code": "96366", "type": "CPT"}], "standard_charges": [{"minimum": 28.62, "maximum": 584.01, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG IV INF INIT", "code_information": [{"code": "96365", "type": "CPT"}], "standard_charges": [{"minimum": 88.21, "maximum": 584.01, "discounted_cash": 265.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAGENESIS, PER SQ CM", "code_information": [{"code": "A2008", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 181.16, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 181.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROCD STRG ENDUR", "code_information": [{"code": "G0237", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.45, "maximum": 19.16, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.45, "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": 49.91, "maximum": 584.01, "gross_charge": 319.33, "discounted_cash": 265.94, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJ. SUCUTANEOUS OR INTRAMUSCULAR 96372", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "2401824", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 20.71, "maximum": 584.01, "gross_charge": 211.0, "discounted_cash": 90.03, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHYLACTIC./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "42624978", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 49.91, "maximum": 584.01, "gross_charge": 319.33, "discounted_cash": 265.94, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY ACTIVATION IPNSS", "code_information": [{"code": "93150", "type": "CPT"}], "standard_charges": [{"minimum": 147.73, "maximum": 584.01, "discounted_cash": 118.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN", "code_information": [{"code": "Q4121", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERMAL DEST. INTRAOSSEOUS NERVE INC. IMAGE 1ST 2 LUMBAR/SACRAL 64628", "code_information": [{"code": "64628", "type": "CPT"}, {"code": "45999709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 495.75, "maximum": 4936.0, "gross_charge": 6735.78, "discounted_cash": 16052.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 2694.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 4041.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 4378.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 495.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERMAL DEST. INTRAOSSEOUS NERVE INC. IMAGE EA. ADD. LUMBAR/SACRAL 64629", "code_information": [{"code": "64629", "type": "CPT"}, {"code": "46008059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 228.48, "maximum": 4936.0, "gross_charge": 4362.63, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1745.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2617.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2835.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 228.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1784.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1898.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3320.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 691.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1011.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 880.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4304.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1527.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1963.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 378.11, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 378.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1867.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 255.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2171.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2054.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1321.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1361.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1658.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1199.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1068.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"minimum": 378.81, "maximum": 6090.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 378.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 560.84, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 462.07, "maximum": 6090.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 462.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 315.35, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 315.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1725.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1126.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1009.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 852.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 937.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 910.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1506.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"minimum": 185.4, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 185.83, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1097.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 583.43, "maximum": 6090.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 583.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1013.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 952.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"minimum": 251.3, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2295.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2907.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 7776.99, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7776.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 624.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 80.16, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 86.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 80.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}], "standard_charges": [{"minimum": 5.19, "maximum": 584.01, "discounted_cash": 7.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 6.17, "maximum": 584.01, "discounted_cash": 8.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.17, "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": 177.63, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 270.38, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 270.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 449.76, "maximum": 4936.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 449.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 412.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 393.58, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 393.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 584.01, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 8.67, "maximum": 584.01, "discounted_cash": 12.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN TIME PARTIAL", "code_information": [{"code": "85732", "type": "CPT"}], "standard_charges": [{"minimum": 5.82, "maximum": 584.01, "discounted_cash": 8.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}], "standard_charges": [{"minimum": 30.96, "maximum": 584.01, "discounted_cash": 45.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26820", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1072.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1074.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUMB TENDON TRANSFER", "code_information": [{"code": "26510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 828.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5445.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78013", "type": "CPT"}], "standard_charges": [{"minimum": 195.61, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 217.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 217.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 234.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 217.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 217.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 195.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78014", "type": "CPT"}], "standard_charges": [{"minimum": 245.77, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 259.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 259.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 280.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 259.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 259.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 245.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING", "code_information": [{"code": "78015", "type": "CPT"}], "standard_charges": [{"minimum": 226.51, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 228.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 228.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 246.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 228.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 228.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 226.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING BODY", "code_information": [{"code": "78018", "type": "CPT"}], "standard_charges": [{"minimum": 310.82, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 363.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 336.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 310.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING/STUDIES", "code_information": [{"code": "78016", "type": "CPT"}], "standard_charges": [{"minimum": 286.57, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 303.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 303.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 328.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 303.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 303.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 286.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET UPTAKE", "code_information": [{"code": "78020", "type": "CPT"}], "standard_charges": [{"minimum": 68.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 73.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 69.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID UPTAKE MEASUREMENT", "code_information": [{"code": "78012", "type": "CPT"}], "standard_charges": [{"minimum": 83.63, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 83.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 83.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 90.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 83.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 83.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [{"code": "626", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6736.01, "maximum": 17308.11, "discounted_cash": 13406.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11423.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11423.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17308.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15164.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9991.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8528.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6736.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [{"code": "625", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12795.87, "maximum": 44941.35, "discounted_cash": 27003.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29661.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29661.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44941.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39374.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25942.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 22145.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 12795.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4926.49, "maximum": 9997.52, "discounted_cash": 11876.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6598.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6598.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9997.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8759.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5771.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4926.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5654.17, "methodology": "case rate"}], "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": 1616.0, "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": 3010.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 10032.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10032.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8246.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29855", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 963.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29856", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1210.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.25ML IM", "code_information": [{"code": "90626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.5ML IM", "code_information": [{"code": "90627", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIES SILK BRAIDED 2-0 12-18 BLK A185H", "code_information": [{"code": "A185H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TILT TABLE EVALUATION", "code_information": [{"code": "93660", "type": "CPT"}], "standard_charges": [{"minimum": 102.35, "maximum": 1270.0, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 111.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 102.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"minimum": 90.93, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 133.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 133.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 133.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIP CANAL FEMORAL FORINTERPULSE BATTERY POWERED IRRIGATIONINTERPULSE", "code_information": [{"code": "210-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP CAUTERY 2.5\" BLADE PTFE 0012", "code_information": [{"code": "12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ELECTROCAUTERY REG EXTENDED 6IN BLADE TYPE COATED", "code_information": [{"code": "E1450-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.17, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ENSEAL 5MM ROUND 45 CM NSEAL545RH", "code_information": [{"code": "NSEAL545RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 855.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP HANDLE SUCTION REG CAPACTY NO TUBING K61", "code_information": [{"code": "K61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.48, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP INSERTER F LARGE 6MM", "code_information": [{"code": "3.820.134S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 683.17, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGARTION SUCTION FEMORAL CANNAL", "code_information": [{"code": "210-008-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP IRRIGATING FEMORAL CANAL PUMPINTERPULSE STRL DISP", "code_information": [{"code": "210008000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO .9MM 45DEG KELMAN MINI ANGLED REPROCESS STRL DISP", "code_information": [{"code": "8065750853R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.9, "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": 1.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION COAXIAL HIGH FLOW", "code_information": [{"code": "210014100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION SIGMOIDAL STERILE 18FR", "code_information": [{"code": "33050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION YANKAUER STANDARD WITHOUT CONTROL VENT", "code_information": [{"code": "34870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.61, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPINSERTER 5MM LG SPINAL STRL", "code_information": [{"code": "3.820.133S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 683.16, "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": 683.16, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1218.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 487.27, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"minimum": 295.28, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 295.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4430.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1485.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L 10 SQ CM/<", "code_information": [{"code": "14060", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1031.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L10.1-30SQCM", "code_information": [{"code": "14061", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1332.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14040", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1023.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14041", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1236.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10 SQ CM/<", "code_information": [{"code": "14020", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 953.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10.1-30 SQCM", "code_information": [{"code": "14021", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1175.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10.1-30SQCM", "code_information": [{"code": "14001", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1132.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"minimum": 10.68, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 6.5, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS TRNSGLTMNASE EA IG CLAS", "code_information": [{"code": "86364", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 584.01, "discounted_cash": 14.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS XPNDR PLMT BRST RCNSTJ", "code_information": [{"code": "19357", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 17230.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1421.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSEEL 2ML", "code_information": [{"code": "MED0203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL 4ML", "code_information": [{"code": "MED0204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 647.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE ADHESIVE 0.4ML SKIN AFFIX APPLICATORS", "code_information": [{"code": "M1204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE ADHESIVE 1.0ML EXOFIN SKIN AFFIX APPLICATORS", "code_information": [{"code": "M1205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE BEDSIDE 5IN X 7 1/2IN 2 PLY", "code_information": [{"code": "NON243275", "type": "CDM"}], "standard_charges": [{"gross_charge": 1.16, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE CULTURE BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}], "standard_charges": [{"minimum": 129.38, "maximum": 584.01, "discounted_cash": 186.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 251.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE LYMPHOCYTE", "code_information": [{"code": "88230", "type": "CPT"}], "standard_charges": [{"minimum": 104.84, "maximum": 584.01, "discounted_cash": 151.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 104.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 104.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}], "standard_charges": [{"minimum": 135.27, "maximum": 584.01, "discounted_cash": 195.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 293.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 135.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 135.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY", "code_information": [{"code": "88233", "type": "CPT"}], "standard_charges": [{"minimum": 126.66, "maximum": 584.01, "discounted_cash": 182.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 259.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 259.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 280.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 259.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 259.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 126.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 126.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 132.77, "maximum": 584.01, "discounted_cash": 191.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 293.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 132.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 132.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM FOR FUNGI", "code_information": [{"code": "87220", "type": "CPT"}], "standard_charges": [{"minimum": 3.84, "maximum": 584.01, "discounted_cash": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE GRAFTS-OTHER (EG.  PARATENON/ FAT/DERMIS) 20926", "code_information": [{"code": "20926", "type": "CPT"}, {"code": "1482245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 1104.19, "gross_charge": 1013.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 965.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250 G", "code_information": [{"code": "58572", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1252.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1097.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 13290.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1464.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 143.96, "maximum": 143.96, "discounted_cash": 207.94, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1982.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TNOT OPN ELBW TO SHO EA TDN", "code_information": [{"code": "24310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 585.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRADEX 0.1%-0.3% OPTH OINT 3.5GM", "code_information": [{"code": "MED0209", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 792.22, "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": 165.4, "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": 43.2, "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": 198.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4064.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.64, "maximum": 33.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 46.66, "maximum": 584.01, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2563.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1212.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3499.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2596.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2811.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3232.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 823.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 571.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOL DC SD12MH30 LGD 12CM DIST 3.0 MH", "code_information": [{"code": "SD12MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4154.13, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 35 CM LNG STRAW FOR PRECISION SPINAL CORD SIMULATOR SYSS", "code_information": [{"code": "SC-4254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOTHPASTE  SPARKLE FRESH FLUORIDE  NONTP85IZZ", "code_information": [{"code": "NONTP85IZZ", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2NTRSPC LMBR", "code_information": [{"code": "22860", "type": "CPT"}], "standard_charges": [{"minimum": 450.7, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 50.3, "maximum": 584.01, "discounted_cash": 72.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 102.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 102.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 111.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 102.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 102.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROGRAPHY ANTERIOR APP. W/DISCECTOMY SECOND LEVEL CERVICAL  22858", "code_information": [{"code": "22858", "type": "CPT"}, {"code": "38612871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 579.24, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 579.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY CERVICAL ANTERIOR APPROACH; SINGLE INTERSPACE 22856", "code_information": [{"code": "22856", "type": "CPT"}, {"code": "1482253<and>1482253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1965.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY LUMBAR ANTERIOR APPROACH 22857", "code_information": [{"code": "22857", "type": "CPT"}, {"code": "1482254", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 21922.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2071.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1236.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1454.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE PACK SOP21TKBW7", "code_information": [{"code": "SOP21TKBW7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 413.84, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 413.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL, per square centimeter", "code_information": [{"code": "Q4330", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 63.6, "maximum": 68.69, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOURNIQUET 18 X 4 DISP DUAL PORT", "code_information": [{"code": "5921-218-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CFF 30IN SNGL PORT SNGL BLADDER REPROCESS W/ PUMP LINE WITHOUT SLEEVE", "code_information": [{"code": "60-7075-105R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION 30IN X 4IN SNGL PORT QUICK REPROCESS DISP", "code_information": [{"code": "5921-030-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION 44IN X 4IN SNGL PORT QUICK REPROCESS DISP", "code_information": [{"code": "5921-044-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION QUICK CONNECT 18IN RED REPROCESSED", "code_information": [{"code": "5921-018-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET COMPRESSION QUICK CONNECT 34IN PURPLE REPROCESSED", "code_information": [{"code": "5921-034-135R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 18 STERILE DISP REPROCESSED", "code_information": [{"code": "60-7070-104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CUFF 18IN REPROCESS STRL DISP", "code_information": [{"code": "60-7070-103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CYLINDRICAL 30IN X 4IN ROYAL BLUE SNGL BLADDER DUAL PORT W/ 40IN TUBI", "code_information": [{"code": "5921-030-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CYLINDRICAL 34IN X 4IN PURPLE SNGL BLADDER DUAL PORT W/ 40IN TUBING C", "code_information": [{"code": "5921-034-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET CYLINDRICAL 44IN X 4IN NAVY BLUE DBL BLADDER W/ 40IN TUBING COLOR CU", "code_information": [{"code": "5921-044-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.48, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUAL PORT 18IN SINGL BLADDER CUFF PLC NO SLEEVE", "code_information": [{"code": "60-7070-103-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUAL PORT 42IN SINGL BLADDER CUFF PLC NO SLEEVE", "code_information": [{"code": "60-7070-107-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET FLAT 1 X 18\" BLUE 10001", "code_information": [{"code": "10001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET PNEUMATIC 34IN X 4IN BLACK 2 PART QUICK REPROCESS", "code_information": [{"code": "5921-034-235R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET STERILE DISP 24 5921-024-235", "code_information": [{"code": "5921-024-235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL OR BLUE STRL", "code_information": [{"code": "BRLBBCT06B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.33, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL STERILE DISPOSABLE OR BLUE 6/PK MDT2168286", "code_information": [{"code": "MDT2168286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL SURGICAL 6PK BLUE LF DISP", "code_information": [{"code": "28700-006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWELS OR BLUE MDT2168284 MDT2168284", "code_information": [{"code": "MDT2168284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWELS; STERILE DISPOSABLE OR TOWEL BLUE MDT2168288", "code_information": [{"code": "MDT2168288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.33, "setting": "both", "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY", "code_information": [{"code": "86777", "type": "CPT"}], "standard_charges": [{"minimum": 12.95, "maximum": 584.01, "discounted_cash": 18.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY IGM", "code_information": [{"code": "86778", "type": "CPT"}], "standard_charges": [{"minimum": 12.97, "maximum": 584.01, "discounted_cash": 18.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 577.67, "maximum": 937.1, "discounted_cash": 834.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 866.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 866.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 937.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 866.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 866.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 277.2, "maximum": 584.01, "discounted_cash": 400.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 449.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81352", "type": "CPT"}], "standard_charges": [{"minimum": 296.56, "maximum": 584.01, "discounted_cash": 428.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 481.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 444.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 584.01, "discounted_cash": 227.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 255.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 235.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 419.55, "maximum": 680.61, "discounted_cash": 606.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 680.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16495.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL LSR ABLT B9 PRST8 HYPR", "code_information": [{"code": "714T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4885.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1318.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULAR METAL TECHNOLOGY VBR-S 11 X 14 X 50.0MM  CURVED 06-115-10501", "code_information": [{"code": "6-115-10501", "type": "CDM"}], "standard_charges": [{"gross_charge": 10948.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 330.69, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 330.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOTOMY LSR W/OCT GDN", "code_information": [{"code": "730T", "type": "CPT"}], "standard_charges": [{"minimum": 2105.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3741.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [{"code": "12", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18314.81, "maximum": 44697.71, "discounted_cash": 37696.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 29500.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 29500.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 44697.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 39161.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25802.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 22025.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18314.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [{"code": "11", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24081.9, "maximum": 57099.97, "discounted_cash": 48767.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 37686.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 37686.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 57099.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 50027.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 32961.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 28137.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24081.9, "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": 11826.95, "maximum": 36835.14, "discounted_cash": 25767.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24311.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24311.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 36835.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 32272.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21263.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 18151.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11826.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [{"code": "4", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63062.19, "maximum": 147994.4, "discounted_cash": 123850.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97677.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97677.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 147994.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 129663.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 85431.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 72927.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 63062.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1409.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1535.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 522.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF ASD", "code_information": [{"code": "93580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1110.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 9225.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3219.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1504.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 1635.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1340.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 12762.26, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12762.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1158.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 253.4, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2807.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3760.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3442.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 8.43, "maximum": 584.01, "discounted_cash": 12.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 8.43, "maximum": 584.01, "discounted_cash": 12.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCYTE, PER SQ CENTIMETER", "code_information": [{"code": "Q4182", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"minimum": 536.89, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 536.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1729.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECTION OR AVULSION OF GREATER OCCIPITAL NERVE 64744", "code_information": [{"code": "64744", "type": "CPT"}, {"code": "45459128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 692.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "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": 405.2, "maximum": 4936.0, "gross_charge": 1013.0, "discounted_cash": 2441.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 405.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 607.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 658.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.22, "maximum": 232.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 214.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 214.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 232.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 214.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1026.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 1151.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 339.14, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 339.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1186.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1109.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1071.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER SKIN PEDICLE FLAP", "code_information": [{"code": "15650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2579.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 777.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 868.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION OF BLOOD OR BLOOD COMPONENTS 36430", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "1482278", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 60.86, "maximum": 4936.0, "gross_charge": 675.0, "discounted_cash": 551.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 60.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 60.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 65.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 60.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 61.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3570.85, "maximum": 7489.54, "discounted_cash": 7142.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4943.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4943.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7489.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6561.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4323.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3690.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3570.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT HIGH F2F 7D", "code_information": [{"code": "99496", "type": "CPT"}], "standard_charges": [{"minimum": 403.72, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 403.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT MOD F2F 14D", "code_information": [{"code": "99495", "type": "CPT"}], "standard_charges": [{"minimum": 297.3, "maximum": 584.01, "discounted_cash": 166.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 297.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7590.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 966.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR APPR. W/DEC. OF SPINAL CORD/NERVE ROOT EA ADD SEG THOR/LUM 63057", "code_information": [{"code": "63057", "type": "CPT"}, {"code": "1740091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 367.87, "maximum": 6887.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR APPROACH W/DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT SINGLE SEG. THORACIC 63055", "code_information": [{"code": "63055", "type": "CPT"}, {"code": "13642411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1983.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD-EQUINA-NERVE ROOTS-LUMBAR 63056", "code_information": [{"code": "63056", "type": "CPT"}, {"code": "1482281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "gross_charge": 4737.0, "discounted_cash": 9072.45, "estimated_discounted_cash": 13838.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 6887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1806.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLACE PROS", "code_information": [{"code": "55875", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 935.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3619.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3613.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3344.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1095.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25310", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 885.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25312", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 878.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT HAND TENDON", "code_information": [{"code": "26480", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 884.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 775.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT PALM TENDON", "code_information": [{"code": "26485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1065.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1149.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1238.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6045.15, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6045.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5916.34, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5916.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2996.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3651.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6573.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6573.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1129.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 139.7, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 139.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 277.05, "maximum": 6090.0, "discounted_cash": 78645.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 277.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 145.31, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 204.52, "maximum": 4936.0, "discounted_cash": 1947.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 204.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1217.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 836.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2857.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1158.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1526.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1639.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6906.49, "maximum": 17893.12, "discounted_cash": 13876.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11809.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11809.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17893.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15676.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 10329.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8817.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6906.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13015.45, "maximum": 32810.25, "discounted_cash": 26108.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21655.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21655.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32810.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28746.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18940.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 16167.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13015.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4265.29, "maximum": 10363.67, "discounted_cash": 8738.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6840.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6840.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10363.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9079.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5982.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5106.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4265.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6453.5, "maximum": 13558.52, "discounted_cash": 13442.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 8948.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 8948.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 13558.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11879.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 7826.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6681.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6453.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4184.43, "maximum": 8491.63, "discounted_cash": 9454.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5604.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5604.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8491.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7439.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4901.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4184.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4193.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3145.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US NON-OB", "code_information": [{"code": "76830", "type": "CPT"}], "standard_charges": [{"minimum": 111.28, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 121.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 111.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US OBSTETRIC", "code_information": [{"code": "76817", "type": "CPT"}], "standard_charges": [{"minimum": 75.13, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 84.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 75.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3932.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAP TEMP SENSING METER LUBRISIL 350CC 16 FR 909516M", "code_information": [{"code": "909516M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 727.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAP WATER WATERLOCK 2 DEFENED DISP", "code_information": [{"code": "6872130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6630.68, "maximum": 19981.27, "discounted_cash": 13162.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13187.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13187.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19981.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17506.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", 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TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1837.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 595.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 978.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE FRACTURE", "code_information": [{"code": "28445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1297.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 209.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 260.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28496", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 720.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1025.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 866.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2027.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1674.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2396.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1047.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21445", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1002.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 322.46, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 322.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 946.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 946.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1096.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1039.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 490.47, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 490.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 625.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 631.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 878.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24640", "type": "CPT"}], "standard_charges": [{"minimum": 141.13, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24586", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1307.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1318.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24620", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 748.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24635", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 845.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT EYELID BY INJECTION", "code_information": [{"code": "68200", "type": "CPT"}], "standard_charges": [{"minimum": 56.11, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26770", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 475.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26775", "type": "CPT"}], "standard_charges": [{"minimum": 579.19, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 579.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26785", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 693.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26720", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 309.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26725", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 520.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26727", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1423.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 603.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26735", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 746.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 345.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26742", "type": "CPT"}], "standard_charges": [{"minimum": 556.11, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 556.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26746", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26750", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 290.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26755", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26765", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT BONE LESION", "code_information": [{"code": "28005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 267.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 456.96, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 456.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 351.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 556.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 509.46, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 509.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 255.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 505.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28606", "type": "CPT"}], "standard_charges": [{"minimum": 513.12, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 513.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOREARM BONE LESION", "code_information": [{"code": "25035", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 742.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 430.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25505", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 775.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25515", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 837.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 838.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1181.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25530", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 397.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25535", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 785.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25560", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 437.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 819.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25574", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 846.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1117.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25600", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 507.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25605", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 834.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE ULNAR STYLOID", "code_information": [{"code": "25652", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 780.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FX DISTAL RADIAL", "code_information": [{"code": "25606", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD EXTRA-ARTICUL", "code_information": [{"code": "25607", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 921.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD INTRA-ARTICUL", "code_information": [{"code": "25608", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1020.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FX RADIAL 3+ FRAG", "code_information": [{"code": "25609", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1281.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND BONE LESION", "code_information": [{"code": "26034", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 695.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 564.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26675", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 677.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26685", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 710.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26686", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 781.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HEEL FRACTURE", "code_information": [{"code": "28415", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1395.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"minimum": 229.15, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 229.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 946.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1147.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1527.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 529.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 435.07, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1344.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1848.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 647.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1966.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2225.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 594.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1207.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1276.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24500", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 546.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24505", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 765.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24515", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1085.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24516", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1052.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 571.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24535", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 908.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24538", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 991.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24545", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1135.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24546", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1259.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 514.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 791.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 910.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24575", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 917.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 539.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 813.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24579", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1030.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24582", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1031.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 812.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 799.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1054.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1244.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1409.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27530", "type": "CPT"}], "standard_charges": [{"minimum": 459.32, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 459.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27532", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 894.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27535", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1076.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1439.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27540", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1006.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE(S)", "code_information": [{"code": "27538", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 708.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 627.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1090.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"minimum": 487.14, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 487.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27524", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 930.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 534.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 720.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21451", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1035.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1007.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21453", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 607.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21461", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2365.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21462", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2686.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 978.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21470", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG BONE LESION", "code_information": [{"code": "27607", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 750.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 572.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 530.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 945.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27824", "type": "CPT"}], "standard_charges": [{"minimum": 470.52, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 470.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 796.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1075.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27827", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1391.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27828", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1626.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG JOINT", "code_information": [{"code": "27829", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26600", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 450.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26605", "type": "CPT"}], "standard_charges": [{"minimum": 495.85, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 495.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 654.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26608", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 612.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26615", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 314.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28475", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 367.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28476", "type": "CPT"}], "standard_charges": [{"minimum": 513.83, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 513.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28485", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": [{"minimum": 504.27, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 504.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 307.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 350.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 825.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 879.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 788.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7401.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 957.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2293.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2066.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC FRACTURE(S)", "code_information": [{"code": "27215", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 973.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 11835.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1139.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 364.96, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 364.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24650", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 397.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24655", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 699.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 821.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24666", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28531", "type": "CPT"}], "standard_charges": [{"minimum": 431.04, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 431.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1321.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1601.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 819.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27176", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1130.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1354.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1130.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1362.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CANAL LESION", "code_information": [{"code": "62282", "type": "CPT"}], "standard_charges": [{"minimum": 455.38, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 455.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62280", "type": "CPT"}], "standard_charges": [{"minimum": 432.11, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 432.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "type": "CPT"}], "standard_charges": [{"minimum": 332.63, "maximum": 4936.0, "discounted_cash": 1105.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 236.17, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 236.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 280.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 655.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 706.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 918.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1104.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1439.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 603.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1184.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1480.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27245", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1477.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27248", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 905.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27516", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 754.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 861.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1070.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1930.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB DISLOCATION", "code_information": [{"code": "26641", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 617.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26650", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 621.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26665", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 227.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 233.4, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 233.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28636", "type": "CPT"}], "standard_charges": [{"minimum": 510.35, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 510.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 196.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28665", "type": "CPT"}], "standard_charges": [{"minimum": 208.15, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 208.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28666", "type": "CPT"}], "standard_charges": [{"minimum": 222.56, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE FRACTURE", "code_information": [{"code": "28525", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1142.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2441.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1429.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24670", "type": "CPT"}], "standard_charges": [{"minimum": 443.56, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 443.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 680.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24685", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 821.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 540.72, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 540.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 70.5, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 249.93, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 461.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25624", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 722.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25628", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 886.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 455.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25635", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 685.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25645", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 720.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25650", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 498.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 586.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 764.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25675", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 760.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 786.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25690", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 635.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25695", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 792.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 683.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25685", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 911.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1594.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 308.66, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 308.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 384.67, "maximum": 4936.0, "discounted_cash": 3470.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 384.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 368.36, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 368.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27786", "type": "CPT"}], "standard_charges": [{"minimum": 462.03, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 462.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27788", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 656.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27792", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 805.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27808", "type": "CPT"}], "standard_charges": [{"minimum": 503.83, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 503.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27810", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 739.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27814", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 945.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"minimum": 503.29, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 503.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27818", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 768.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27822", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1093.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27823", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1221.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28430", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 351.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 544.48, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 544.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28436", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 654.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BLADDER LESION", "code_information": [{"code": "51720", "type": "CPT"}], "standard_charges": [{"minimum": 122.15, "maximum": 4936.0, "discounted_cash": 871.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BONE CYST", "code_information": [{"code": "20615", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 332.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 716.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 448.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 83.91, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 83.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27780", "type": "CPT"}], "standard_charges": [{"minimum": 465.71, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 465.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27781", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 646.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27784", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 890.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28002", "type": "CPT"}], "standard_charges": [{"minimum": 324.85, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 324.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 502.36, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 502.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1939.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1923.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28400", "type": "CPT"}], "standard_charges": [{"minimum": 358.74, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 358.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 660.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28406", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 726.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59812", "type": "CPT"}], "standard_charges": [{"minimum": 465.52, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 465.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"minimum": 554.09, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 554.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 333.61, "maximum": 4936.0, "discounted_cash": 4145.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 767.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 3631.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 637.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 161.16, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 161.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 658.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"minimum": 333.19, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 333.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 222.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 815.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 696.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4915.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1086.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1254.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1573.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 859.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1160.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27500", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 757.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 725.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27502", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 989.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 989.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27506", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1166.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 765.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27509", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 860.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27510", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 885.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27511", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1189.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1462.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1155.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27750", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 520.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27752", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 800.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27756", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 744.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27758", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1099.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27759", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 16052.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2105.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 952.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1212.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28515", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 231.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 560.49, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53260", "type": "CPT"}], "standard_charges": [{"minimum": 285.43, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 285.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}], "standard_charges": [{"minimum": 309.14, "maximum": 4936.0, "discounted_cash": 2613.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 309.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"minimum": 459.49, "maximum": 4936.0, "discounted_cash": 687.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 459.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM", "code_information": [{"code": "86780", "type": "CPT"}], "standard_charges": [{"minimum": 11.92, "maximum": 584.01, "discounted_cash": 17.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 10.96, "maximum": 584.01, "discounted_cash": 15.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 10.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 10.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRG GENE REARRANGEMENT ANAL", "code_information": [{"code": "81342", "type": "CPT"}], "standard_charges": [{"minimum": 181.35, "maximum": 584.01, "discounted_cash": 261.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 371.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 371.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 401.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 371.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 371.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 181.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 181.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 311+", "code_information": [{"code": "239U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 3150.0, "discounted_cash": 4550.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3150.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3150.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 55-74", "code_information": [{"code": "242U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 4500.0, "discounted_cash": 6500.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 83+", "code_information": [{"code": "326U", "type": "CPT"}], "standard_charges": [{"minimum": 4500.0, "maximum": 4500.0, "discounted_cash": 6500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 1367.15, "discounted_cash": 1974.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1367.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1367.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 194 GENES", "code_information": [{"code": "50U", "type": "CPT"}], "standard_charges": [{"minimum": 2624.94, "maximum": 4258.24, "discounted_cash": 3791.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3937.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3937.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4258.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3937.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3937.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2624.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2624.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 324 GENES", "code_information": [{"code": "37U", "type": "CPT"}], "standard_charges": [{"minimum": 3150.0, "maximum": 5110.0, "discounted_cash": 4550.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4725.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4725.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5110.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4725.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4725.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3150.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3150.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80438", "type": "CPT"}], "standard_charges": [{"minimum": 45.37, "maximum": 584.01, "discounted_cash": 65.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 92.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 92.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 100.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 92.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 92.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 45.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 45.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80439", "type": "CPT"}], "standard_charges": [{"minimum": 60.49, "maximum": 584.01, "discounted_cash": 87.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 123.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 123.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 133.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 123.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 123.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACETONIDE (KENALOG-40) 40MG", "code_information": [{"code": "MED0210", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TRICHINELLA ANTIBODY", "code_information": [{"code": "86784", "type": "CPT"}], "standard_charges": [{"minimum": 11.3, "maximum": 584.01, "discounted_cash": 16.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOGRAM", "code_information": [{"code": "96902", "type": "CPT"}], "standard_charges": [{"minimum": 42.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS ASSAY W/OPTIC", "code_information": [{"code": "87808", "type": "CPT"}], "standard_charges": [{"minimum": 13.76, "maximum": 584.01, "discounted_cash": 19.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGIN DIR PROBE", "code_information": [{"code": "87660", "type": "CPT"}], "standard_charges": [{"minimum": 18.05, "maximum": 584.01, "discounted_cash": 26.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGINALIS AMPLIF", "code_information": [{"code": "87661", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICYCLIC & CYCLICALS 6/MORE", "code_information": [{"code": "80337", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 0.9, "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": 578.59, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.65, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 19.39, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1721.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 789.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 563.87, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 563.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 730.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 840.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 8117.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 8117.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 1748.82, "maximum": 8117.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 1635.0, "maximum": 8117.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 1748.82, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 898.35, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1241.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1241.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1342.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1241.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1241.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 827.62, "maximum": 4936.0, "discounted_cash": 7116.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 895.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 827.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 2477.93, "discounted_cash": 3579.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 2843.48, "discounted_cash": 4107.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 576.66, "maximum": 584.01, "discounted_cash": 832.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 576.66, "maximum": 576.66, "discounted_cash": 832.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1336.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROCAR 5MMX100MM CANN/SEAL", "code_information": [{"code": "CTS02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 148.01, "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": 769.7, "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": 548.94, "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": 209.07, "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": 375.22, "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": 610.37, "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": 75.35, "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": 74.53, "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": 75.35, "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": 75.35, "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": 487.09, "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": 144.37, "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": 879.2, "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": 516.01, "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": 120.86, "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": 682.96, "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": 294.3, "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": 442.22, "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": 351.47, "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": 291.28, "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": 249.67, "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": 548.94, "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": 656.1, "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": 682.34, "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": 291.28, "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": 291.28, "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": 249.67, "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": 179.19, "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": 125.35, "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": 125.35, "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": 291.28, "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": 165.5, "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": 291.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SLEEVE 12MM XCEL", "code_information": [{"code": "2CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.13, "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": 347.56, "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": 528.13, "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": 476.99, "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": 155.91, "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": 125.35, "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": 531.63, "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": 306.45, "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": 174.52, "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": 531.63, "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": 231.53, "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": 156.29, "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": 156.29, "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": 421.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR WOUND TUBING 1/8IN", "code_information": [{"code": "MCK8437", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.28, "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": 692.74, "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": 510.85, "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": 610.01, "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": 521.07, "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": 407.71, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLUNT TIP 12MMX100MM 2H12LP", "code_information": [{"code": "2H12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 816.79, "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": 679.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 1477.0, "maximum": 4936.0, "discounted_cash": 16495.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4465.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRUSKIN, PER SQ CENTIMETER", "code_information": [{"code": "Q4167", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPAN BLUE 0.06% (VISION BLUE) OPHTHALMIC SOLUTION 0.5ML", "code_information": [{"code": "MED0212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 233.47, "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": 15.12, "maximum": 584.01, "gross_charge": 50.0, "discounted_cash": 21.84, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE F-UP OR LMTD", "code_information": [{"code": "93308", "type": "CPT"}], "standard_charges": [{"minimum": 99.9, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 175.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 175.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 189.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 175.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O CONTR, CONT ECG", "code_information": [{"code": "C8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CON,STRES", "code_information": [{"code": "C8928", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, COM", "code_information": [{"code": "C8921", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, F/U", "code_information": [{"code": "C8922", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR WO FOL WCON,DOPPLER", "code_information": [{"code": "C8929", "type": "HCPCS"}], "standard_charges": [{"minimum": 1363.76, "maximum": 1472.86, "discounted_cash": 980.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1472.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1363.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/DOPPLER COMPLETE", "code_information": [{"code": "93306", "type": "CPT"}], "standard_charges": [{"minimum": 168.9, "maximum": 584.01, "discounted_cash": 683.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 295.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 295.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 319.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 295.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 168.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 124.42, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 155.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 155.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 167.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 155.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 124.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTL1LYR 16FR10ML 100%SIL TMP TRAY", "code_information": [{"code": "URO170816T", "type": "CDM"}], "standard_charges": [{"gross_charge": 157.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 4015.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE 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"TUBE ENDO 6MM ORAL RAE UNCUFFED PERFORMED CURVE STRL", "code_information": [{"code": "86269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.59, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.0MM HIGH VOLUME LOW PRESSURE SHRT CUFF MAGILL CURVE ORAL OR NASAL PO", "code_information": [{"code": "86450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.5MM MURPHY EYE CFFD NASAL RAE LF STRL DISP", "code_information": [{"code": "86215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 7.5MM ORAL RAE MURPHY EYE TIP PREFORMED CURVE LF", "code_information": [{"code": "86205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 79MM 12.2MM 7.6MM SZ 8 CFFDINNER CANNULA LOW PRESSURE SHILEY LF DISP", "code_information": [{"code": "8DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8.0MM HIGH VOLUME LOW PRESSURE SHRT CUFF ORAL OR NASAL MAGILL CURVE PO", "code_information": [{"code": "86452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 8.0MM X 11.3MM EMG MONITOR REINFORCED PROTECTED PIN NIM DISP", "code_information": [{"code": "8229308", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1033.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 6MM LF", "code_information": [{"code": "76260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 7MM LF", "code_information": [{"code": "76270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO ORAL RAE W/ TAPERGUARD CUFF 8MM LF", "code_information": [{"code": "76280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO SZ 6 CUFFED LOW PRESSUREINNER CANNULA LF ADLT", "code_information": [{"code": "6DCT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 6MM NASAL RAE CUFFED PREFORMED LF STRL DISP", "code_information": [{"code": "86212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.5MM THIN CUFFINTERMED HI LO", "code_information": [{"code": "86451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 6.0 NIM 8229306", "code_information": [{"code": "8229306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1234.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.0 NIM 8229307", "code_information": [{"code": "8229307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.0ID X 9.5OD MM MALLINCKRODT CUFFLESS NASAL RAE", "code_information": [{"code": "96370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACHEAL 7.5ID X 10.2OD MM MALLINCKRODT CUFFLESS NASAL RAE", "code_information": [{"code": "96375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.77, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET 6MM CUF MRPH EYE PREFRM CRV NSLRAE STRL LF DISP", "code_information": [{"code": "96360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.21, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET CUF MRPHCRV NSLRAE STRL LF DISP 6.5MM", "code_information": [{"code": "96365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE FDNG 14FR X 48IN DUAL LUMEN STOMACH ANTI REFLUX VALVE 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NASOGASTRIC 18FR W/ PREVENT FILTER", "code_information": [{"code": "46180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NG 36IN 10FR 2 LUM PRV ANRFLX FLTR SUMP PRV STRL LF", "code_information": [{"code": "46100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NG TUBE W/PREVENT FILTER 12FR 0046120", "code_information": [{"code": "46120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION 12FR FRAZIER", "code_information": [{"code": "NL1903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION 12FR UNIVERSAL CONNECTOR FRAZIER CONTROL VENT ERGONOMIC HANDLE LATEX FREE STERILE", "code_information": [{"code": "DYNDFR12S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION 7FR FRAZIER", "code_information": [{"code": "NL1900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUMP SALEM 14 FR 0042140", "code_information": [{"code": "42140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACH ORAL RAE CUFFED 7.5 76275", "code_information": [{"code": "76275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACH SHILEY EXT SZ8 80XLTCD", "code_information": [{"code": "80XLTCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY 6MM PROXIMAL EXTENDED LEN CUFFED SHILEY", "code_information": [{"code": "60XLTCP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY 7MM RPOXIMAL EXTENDED LEN CUFFED SHILEY", "code_information": [{"code": "70XLTCP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE TRACHEOSTOMY 8MM PROXIMAL EXTENDED LEN CUFFED SHILEY", "code_information": [{"code": "80XLTCP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV 36IN SECONDARY SET BAG HANGER SPIN MALE", "code_information": [{"code": "MS3500-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING J-LOOP EXTENSION SET 7N8301", "code_information": [{"code": "7N8301", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 10.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING N-COND 6MM 12' CLR STR", "code_information": [{"code": "CFN612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING OXYGEN 14FT GREEN STAR LUMEN", "code_information": [{"code": "1980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET ALARIAS BD PUMP MODULE ADMINISTRATION 11171447", "code_information": [{"code": "11171447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SMART CAPNOLINE H PLUS OXYGEN 010433", "code_information": [{"code": "10433", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SMART SET 3 S CLAMP NEEDLE FREE", "code_information": [{"code": "2426-0007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.11, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCT 1/4IN X 12FT CLR NONCONDUCTIVE SMTH PLSTC W/ MAXI GRIP CONNECTORS AN", "code_information": [{"code": "N612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCT 3/16IN X 12FT CLR NON CONDUCTIVE W/ MAXI GRIP CONNECTORS AND MALE/MA", "code_information": [{"code": "N512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING TRANSFER SPIKE BT945", "code_information": [{"code": "BT945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR IMMUNOHISTOCHEM/COMPUT", "code_information": [{"code": "88361", "type": "CPT"}], "standard_charges": [{"minimum": 97.45, "maximum": 584.01, "discounted_cash": 448.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 119.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 255.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 28CM M365SC42520", "code_information": [{"code": "M365SC42520", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 636.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"minimum": 683.15, "maximum": 1108.21, "discounted_cash": 986.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1024.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1024.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1108.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1024.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1024.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"minimum": 116.48, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 116.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 207.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 228.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX GASTRO INTUB W/ASP", "code_information": [{"code": "43753", "type": "CPT"}], "standard_charges": [{"minimum": 27.2, "maximum": 4936.0, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX L/R ATRIAL FIB ADDL", "code_information": [{"code": "93657", "type": "CPT"}], "standard_charges": [{"minimum": 342.66, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 342.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN W/PACKING", "code_information": [{"code": "12021", "type": "CPT"}], "standard_charges": [{"minimum": 245.57, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 28.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 381.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, 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"standard_charge_dollar": 9942.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 8487.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5642.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3308.75, "maximum": 6714.57, "discounted_cash": 7643.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4431.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4431.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6714.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5882.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3876.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3308.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3881.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNDERWEARINCONTINENCE MED 4/20S PRTCTV PULL UP 7 HEAVY ABSORBENCY LEVEL PROTECTI", "code_information": [{"code": "MSC33005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.33, "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": 210.37, "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": 99.4, "setting": "both", "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 58.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX SKN MUC MEMB SUBQ", "code_information": [{"code": "17999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH 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584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV SVC/PROCEDURE", "code_information": [{"code": "93799", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 1270.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIALYSIS PROCEDURE", "code_information": [{"code": "90999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 1270.0, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX RADIOGRAPHIC PX", "code_information": [{"code": "76499", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUOROSCOPIC PX", "code_information": [{"code": "76496", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HOME VISIT SVC/PX", "code_information": [{"code": "99600", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTSC PX UTERUS", "code_information": [{"code": "58579", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BLADDER", "code_information": [{"code": "51999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ESOPH", "code_information": [{"code": "43289", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX INTESTINE", "code_information": [{"code": "44238", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LIVER", "code_information": [{"code": "47379", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [{"code": "58679", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX TESTIS", "code_information": [{"code": "54699", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX UTERUS", "code_information": [{"code": "58578", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MODALITY", "code_information": [{"code": "97039", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX DX NUC", "code_information": [{"code": "78399", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCULOSKELETAL PROCEDURE-HEAD 21499", "code_information": [{"code": "21499", "type": "CPT"}, {"code": "1482312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 270.4, "maximum": 4936.0, "gross_charge": 676.0, "discounted_cash": 296.14, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 270.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 439.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NECROPSY (AUTOPSY)", "code_information": [{"code": "88099", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NEUROLOGICAL DX PX", "code_information": [{"code": "95999", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK 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1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED OPH SVC/PROCEDURE", "code_information": [{"code": "92499", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PHYSCL MED/REHAB PX", "code_information": [{"code": "97799", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PREVENTIVE SERVICE", "code_information": [{"code": "99429", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDUE NECK OR THORAX  21899", "code_information": [{"code": "21899", "type": "CPT"}, {"code": "10956157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 3437.0, "discounted_cash": 296.14, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2062.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 2234.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ANUS", "code_information": [{"code": "46999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE BREAST", "code_information": [{"code": "19499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4895.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EYELIDS", "code_information": [{"code": "67999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE FEMUR OR KNEE 27599", "code_information": [{"code": "27599", "type": "CPT"}, {"code": "1668561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 308.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE NOSE", "code_information": [{"code": "30999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1162.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SHOULDER", "code_information": [{"code": "23929", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE STOMACH", "code_information": [{"code": "43999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-HIP JOINT OR PELVIS 27299", "code_information": [{"code": "27299", "type": "CPT"}, {"code": "1482319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 1690.0, "discounted_cash": 308.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 1014.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 1098.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-MUSCULOSKELETAL SYSTEM 20999", "code_information": [{"code": "20999", "type": "CPT"}, {"code": "1482321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 308.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-NERVOUS SYSTEM 64999", "code_information": [{"code": "64999", "type": "CPT"}, {"code": "1482326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 383.79, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE-SPINE 22899", "code_information": [{"code": "22899", "type": "CPT"}, {"code": "1482324", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "discounted_cash": 308.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PSYC SVC/THERAPY", "code_information": [{"code": "90899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABD PERTM&OMN", "code_information": [{"code": "49999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABDOMEN MUSCSKEL", "code_information": [{"code": "22999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ACCESSORY SINUS", "code_information": [{"code": "31299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ANT SEGMENT EYE", "code_information": [{"code": "66999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ARTHROSCOPY", "code_information": [{"code": "29999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 127.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DENTALVLR STRUX", "code_information": [{"code": "41899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXC PRESSURE ULC", "code_information": [{"code": "15999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 885.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTERNAL EAR", "code_information": [{"code": "69399", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FML GENITAL SYS", "code_information": [{"code": "58999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOOT/TOES", "code_information": [{"code": "28899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOREARM/WRIST", "code_information": [{"code": "25999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HANDS/FINGERS", "code_information": [{"code": "26989", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HUMERUS/ELBOW", "code_information": [{"code": "24999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 396.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LEG/ANKLE", "code_information": [{"code": "27899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 308.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MALE GENITAL SYS", "code_information": [{"code": "55899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 252.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 168.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MIDDLE EAR", "code_information": [{"code": "69799", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PALATE UVULA", "code_information": [{"code": "42299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PHRNX ADND/TNSL", "code_information": [{"code": "42999", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 168.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 249.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX URINARY SYSTEM", "code_information": [{"code": "53899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 312.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 296.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPEC DERM SVC/PX", "code_information": [{"code": "96999", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPECIAL SVC PX/RPRT", "code_information": [{"code": "99199", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 44.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 2.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 20.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VACCINE/TOXOID", "code_information": [{"code": "90749", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX ABD PERTM&OMN", "code_information": [{"code": "49329", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX HRNAP HRNRPHY", "code_information": [{"code": "49659", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 7558.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNUSUAL PHYSICIAN TRAVEL", "code_information": [{"code": "99082", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 2880.0, "maximum": 2880.0, "discounted_cash": 4160.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 560.0, "maximum": 9225.0, "discounted_cash": 13068.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 9225.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7582.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93930", "type": "CPT"}], "standard_charges": [{"minimum": 211.8, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 373.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 373.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 403.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 373.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 211.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93931", "type": "CPT"}], "standard_charges": [{"minimum": 128.35, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 255.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 255.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 276.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 255.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7558.98, "maximum": 38909.53, "discounted_cash": 15181.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25680.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25680.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38909.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34090.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22460.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 19173.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7558.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "255", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11677.44, "maximum": 63409.85, "discounted_cash": 24118.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41850.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41850.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 63409.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 55555.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36604.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 31246.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11677.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "257", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3980.55, "maximum": 28307.72, "discounted_cash": 9765.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18683.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18683.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28307.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24801.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 16340.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13949.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3980.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPR GI SCOPE W/SUBMUC INJ", "code_information": [{"code": "43236", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/L XTREMITY ART 2 LEVELS", "code_information": [{"code": "93922", "type": "CPT"}], "standard_charges": [{"minimum": 93.77, "maximum": 584.01, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 149.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 138.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/LXTR ART STDY 3+ LVLS", "code_information": [{"code": "93923", "type": "CPT"}], "standard_charges": [{"minimum": 146.56, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 210.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 210.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 227.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 210.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 146.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 3.2, "maximum": 584.01, "discounted_cash": 8.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 3.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 4.62, "maximum": 584.01, "discounted_cash": 6.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA-N CLEARANCE TEST", "code_information": [{"code": "84545", "type": "CPT"}], "standard_charges": [{"minimum": 6.48, "maximum": 584.01, "discounted_cash": 9.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY", "code_information": [{"code": "50970", "type": "CPT"}], "standard_charges": [{"minimum": 440.33, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 440.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50955", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 595.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 560.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & CATHETER", "code_information": [{"code": "50972", "type": "CPT"}], "standard_charges": [{"minimum": 425.81, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 425.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2133.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1754.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50957", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 601.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50961", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 543.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50976", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 552.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50980", "type": "CPT"}], "standard_charges": [{"minimum": 423.18, "maximum": 4936.0, "discounted_cash": 6703.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 423.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2330.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}], "standard_charges": [{"minimum": 237.44, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 237.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 237.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 256.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 237.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 237.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 253.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7692.87, "maximum": 15754.04, "discounted_cash": 16049.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10397.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10397.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15754.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13802.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9094.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7763.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7692.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4884.31, "maximum": 12041.62, "discounted_cash": 9652.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7947.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7947.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12041.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10550.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6951.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5933.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4884.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3801.19, "maximum": 7713.91, "discounted_cash": 9637.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5091.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5091.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7713.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6758.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4452.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3801.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4471.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRLYS TRANSVAG W/ SCOPE", "code_information": [{"code": "53500", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4407.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 902.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS", "code_information": [{"code": "81005", "type": "CPT"}], "standard_charges": [{"minimum": 1.95, "maximum": 584.01, "discounted_cash": 2.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS GLASS TEST", "code_information": [{"code": "81020", "type": "CPT"}], "standard_charges": [{"minimum": 4.23, "maximum": 584.01, "discounted_cash": 6.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/SCOPE", "code_information": [{"code": "81000", "type": "CPT"}], "standard_charges": [{"minimum": 3.62, "maximum": 584.01, "discounted_cash": 5.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS VOLUME MEASURE", "code_information": [{"code": "81050", "type": "CPT"}], "standard_charges": [{"minimum": 3.28, "maximum": 584.01, "discounted_cash": 4.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 84.06, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 90.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 84.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 85.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 73.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 249.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6562.4, "maximum": 14769.84, "discounted_cash": 12021.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9748.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9748.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14769.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12940.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8526.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7278.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6562.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3487.39, "maximum": 8230.09, "discounted_cash": 6989.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5431.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5431.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8230.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7210.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4750.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4055.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3487.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE BACTERIA CULTURE", "code_information": [{"code": "87088", "type": "CPT"}], "standard_charges": [{"minimum": 7.28, "maximum": 584.01, "discounted_cash": 10.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 14.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 14.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"minimum": 7.7, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE MEER BAG FOLEY SYSTEM IC PLUS BARDEX 153214A", "code_information": [{"code": "153214A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.35, "setting": "both", "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 4.73, "maximum": 584.01, "discounted_cash": 38.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1483.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.7, "maximum": 1100.0, "discounted_cash": 12.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY ANTEGRADE RS&I", "code_information": [{"code": "74425", "type": "CPT"}], "standard_charges": [{"minimum": 63.95, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 63.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY IV +-KUB TOMOG", "code_information": [{"code": "74400", "type": "CPT"}], "standard_charges": [{"minimum": 109.69, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 109.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 109.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 118.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 109.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 109.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BLS W/NF", "code_information": [{"code": "74415", "type": "CPT"}], "standard_charges": [{"minimum": 140.52, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 151.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BOLUS", "code_information": [{"code": "74410", "type": "CPT"}], "standard_charges": [{"minimum": 107.51, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 107.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 107.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY RTRGR +-KUB", "code_information": [{"code": "74420", "type": "CPT"}], "standard_charges": [{"minimum": 73.82, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 138.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDL AORTA SCREEN AAA", "code_information": [{"code": "76706", "type": "CPT"}], "standard_charges": [{"minimum": 81.36, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 81.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 104.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE DENSITY MEASURE", "code_information": [{"code": "76977", "type": "CPT"}], "standard_charges": [{"minimum": 5.04, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE STIMULATION", "code_information": [{"code": "20979", "type": "CPT"}], "standard_charges": [{"minimum": 73.18, "maximum": 4936.0, "discounted_cash": 36.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 73.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US COMPL JOINT R-T W/IMG", "code_information": [{"code": "76881", "type": "CPT"}], "standard_charges": [{"minimum": 14.28, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 114.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL COMP", "code_information": [{"code": "76770", "type": "CPT"}], "standard_charges": [{"minimum": 94.65, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL LIM", "code_information": [{"code": "76775", "type": "CPT"}], "standard_charges": [{"minimum": 44.04, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDOM COMPLETE", "code_information": [{"code": "76700", "type": "CPT"}], "standard_charges": [{"minimum": 100.33, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 123.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 123.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 133.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 123.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 123.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 100.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM CHEST", "code_information": [{"code": "76604", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 81.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS DYNAMIC", "code_information": [{"code": "76885", "type": "CPT"}], "standard_charges": [{"minimum": 127.49, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 147.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 127.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS STATIC", "code_information": [{"code": "76886", "type": "CPT"}], "standard_charges": [{"minimum": 89.58, "maximum": 584.01, "discounted_cash": 108.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 93.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 93.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 93.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 93.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM K TRANSPL W/DOPPLER", "code_information": [{"code": "76776", "type": "CPT"}], "standard_charges": [{"minimum": 141.94, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 142.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 142.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 154.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 142.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 142.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM OF HEAD AND NECK", "code_information": [{"code": "76536", "type": "CPT"}], "standard_charges": [{"minimum": 107.78, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 124.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 107.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM PELVIC COMPLETE", "code_information": [{"code": "76856", "type": "CPT"}], "standard_charges": [{"minimum": 95.52, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM PELVIC LIMITED", "code_information": [{"code": "76857", "type": "CPT"}], "standard_charges": [{"minimum": 35.72, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM SCROTUM", "code_information": [{"code": "76870", "type": "CPT"}], "standard_charges": [{"minimum": 51.07, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 55.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM SPINAL CANAL", "code_information": [{"code": "76800", "type": "CPT"}], "standard_charges": [{"minimum": 100.58, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 100.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 100.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 108.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 100.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 100.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE INTRAOP", "code_information": [{"code": "76998", "type": "CPT"}], "standard_charges": [{"minimum": 128.82, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 128.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 128.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 139.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 128.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 128.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE TISSUE ABLATION", "code_information": [{"code": "76940", "type": "CPT"}], "standard_charges": [{"minimum": 82.04, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE VASCULAR ACCESS", "code_information": [{"code": "76937", "type": "CPT"}], "standard_charges": [{"minimum": 25.45, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LEIOMYOMATA ABLATE <200", "code_information": [{"code": "71T", "type": "CPT"}], "standard_charges": [{"minimum": 2829.0, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LMTD JT/FCL EVL NVASC XTR", "code_information": [{"code": "76882", "type": "CPT"}], "standard_charges": [{"minimum": 13.28, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 41.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US NRV&ACC STRUX 1XTR COMPRE", "code_information": [{"code": "76883", "type": "CPT"}], "standard_charges": [{"minimum": 21.27, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRANSRECTAL", "code_information": [{"code": "76872", "type": "CPT"}], "standard_charges": [{"minimum": 71.47, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 77.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 71.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 115.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB 1ST LES", "code_information": [{"code": "76978", "type": "CPT"}], "standard_charges": [{"minimum": 126.61, "maximum": 584.01, "discounted_cash": 436.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 301.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 301.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 325.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 301.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 301.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 126.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB EA ADDL", "code_information": [{"code": "76979", "type": "CPT"}], "standard_charges": [{"minimum": 88.26, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 220.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 220.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 237.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 220.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 220.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE 1ST TARGET LESION", "code_information": [{"code": "76982", "type": "CPT"}], "standard_charges": [{"minimum": 81.8, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 81.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 81.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 88.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 81.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 81.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 84.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE EA ADDL TARGET LESION", "code_information": [{"code": "76983", "type": "CPT"}], "standard_charges": [{"minimum": 41.65, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 45.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE OF SPEECH DEVICE SERVICE", "code_information": [{"code": "92609", "type": "CPT"}], "standard_charges": [{"minimum": 140.8, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 211.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 211.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 227.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 211.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE PARENCHYMA", "code_information": [{"code": "76981", "type": "CPT"}], "standard_charges": [{"minimum": 95.82, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 95.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Dipstick", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "1093835", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 2.03, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 2.93, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Dipstick POC", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "17082559", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 2.03, "maximum": 584.01, "gross_charge": 10.0, "discounted_cash": 2.93, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 2.03, "maximum": 584.01, "gross_charge": 11.0, "discounted_cash": 2.93, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Drug Screen G0479", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "43031523", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 55.93, "maximum": 584.01, "gross_charge": 137.0, "discounted_cash": 80.78, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 116.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 107.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 55.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 55.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Urine Pregnancy Test POC", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "607612", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.75, "maximum": 584.01, "gross_charge": 10.0, "discounted_cash": 11.19, "estimated_discounted_cash": 10.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACC IIV4 NO PRSRV 0.25ML IM", "code_information": [{"code": "90689", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACCINA IG IM", "code_information": [{"code": "90393", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACCINIA VRS VAC 0.3 ML PERQ", "code_information": [{"code": "90622", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1350.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1458.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCLUDING T/O", "code_information": [{"code": "58262", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1093.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 9271.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1536.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE COMPL", "code_information": [{"code": "58294", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1428.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE REPAIR", "code_information": [{"code": "58270", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1058.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/T/O & VAG REPAIR", "code_information": [{"code": "58263", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1171.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1254.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6900.35, "maximum": 14003.13, "discounted_cash": 15532.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9242.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9242.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14003.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12268.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8083.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6900.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7473.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4263.06, "maximum": 11923.24, "discounted_cash": 7686.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7869.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7869.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11923.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10446.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6882.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5875.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4263.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C", "code_information": [{"code": "768", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8117.0, "maximum": 21851.94, "discounted_cash": 9581.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 14422.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 14422.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 21851.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19145.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 12614.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 10768.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8117.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC", "code_information": [{"code": "797", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3814.0, "maximum": 11657.58, "discounted_cash": 8944.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7694.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7694.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11657.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10213.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6729.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5744.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3814.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC", "code_information": [{"code": "796", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3814.0, "maximum": 20209.77, "discounted_cash": 10434.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 13338.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 13338.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20209.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17706.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11666.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 9958.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3814.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC", "code_information": [{"code": "798", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3814.0, "maximum": 11657.58, "discounted_cash": 8557.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 7694.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 7694.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 11657.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 10213.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6729.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 5744.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3814.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [{"code": "806", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3691.0, "maximum": 9737.36, "discounted_cash": 6741.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6426.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6426.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9737.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8531.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5621.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4798.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3691.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [{"code": "805", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3691.0, "maximum": 14084.35, "discounted_cash": 9649.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 9295.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 9295.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 14084.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 12339.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 8130.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 6940.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3691.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC", "code_information": [{"code": "807", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2634.0, "maximum": 8451.71, "discounted_cash": 6028.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 5578.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 5578.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 8451.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 7404.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 4878.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4164.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 2634.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58260", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6254.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2136.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1462.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1478.04, "methodology": "fee schedule"}], "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": 7.71, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SALEM SUMP ANTI-REFLUX", "code_information": [{"code": "88-266197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.36, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33390", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2323.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2780.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3756.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2982.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN  500MG VIAL", "code_information": [{"code": "MED0213", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.74, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1 GRAM VIAL", "code_information": [{"code": "MED0214", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.91, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1GM/NS 250ML IVPB", "code_information": [{"code": "MED0215", "type": "CDM"}], "standard_charges": [{"gross_charge": 16.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANO MIXTURE (VIGAMOX,ALPHAGAN,NEVANAC,OMNIPRED 0.15ML", "code_information": [{"code": "MED0216", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANOMYCIN DNA AMP PROBE", "code_information": [{"code": "87500", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 584.01, "discounted_cash": 45.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 69.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 64.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAPOR-CLEAN CARTON OF 8 PAIR OF FILTERS 101", "code_information": [{"code": "101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.12, "setting": "both", "billing_class": "facility"}]}, {"description": "VAR VACCINE LIVE SUBQ", "code_information": [{"code": "90716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AG IF", "code_information": [{"code": "87290", "type": "CPT"}], "standard_charges": [{"minimum": 12.08, "maximum": 584.01, "discounted_cash": 17.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER ANTIBODY", "code_information": [{"code": "86787", "type": "CPT"}], "standard_charges": [{"minimum": 11.59, "maximum": 584.01, "discounted_cash": 16.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "discounted_cash": 2890.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8773.11, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8773.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8042.87, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8042.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 10515.54, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10515.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 5777.55, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5777.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC GRAFT INTO CARPAL BONE", "code_information": [{"code": "25430", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 917.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR BIOPSY", "code_information": [{"code": "75970", "type": "CPT"}], "standard_charges": [{"minimum": 503.08, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 503.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 503.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 544.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 503.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 503.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 184.03, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 184.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 184.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 199.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 184.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 184.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93975", "type": "CPT"}], "standard_charges": [{"minimum": 269.41, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 485.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 485.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 524.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 485.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 269.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93976", "type": "CPT"}], "standard_charges": [{"minimum": 155.51, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93978", "type": "CPT"}], "standard_charges": [{"minimum": 186.84, "maximum": 584.01, "discounted_cash": 298.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 347.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 347.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 375.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 347.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 186.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93979", "type": "CPT"}], "standard_charges": [{"minimum": 122.67, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 242.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 242.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 261.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 242.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 122.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 16.37, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 35.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 35.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 35.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1369.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1369.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 3001.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3001.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4047.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1056.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INTMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}], "standard_charges": [{"minimum": 506.2, "maximum": 584.01, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMONITORED", "code_information": [{"code": "95711", "type": "CPT"}], "standard_charges": [{"minimum": 506.2, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 506.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1963.33, "discounted_cash": 1073.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1817.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1817.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1963.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1817.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1048.92, "discounted_cash": 466.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1048.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 971.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1970.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1701.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1584.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11970.21, "maximum": 30452.31, "discounted_cash": 27337.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20098.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20098.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30452.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26680.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17578.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15006.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 11970.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 95.52, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 132.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 147.04, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 159.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 147.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 77.32, "maximum": 584.01, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 110.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 77.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARMS/LEGS", "code_information": [{"code": "75822", "type": "CPT"}], "standard_charges": [{"minimum": 86.51, "maximum": 584.01, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 126.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 126.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 136.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 126.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 126.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY CHEST", "code_information": [{"code": "75827", "type": "CPT"}], "standard_charges": [{"minimum": 86.94, "maximum": 584.01, "discounted_cash": 1968.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 122.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 95.52, "maximum": 584.01, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 132.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 122.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEY", "code_information": [{"code": "75831", "type": "CPT"}], "standard_charges": [{"minimum": 89.84, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 131.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 93.77, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - 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BLUE NETWORK E", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 130.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 94.21, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 120.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 129.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 120.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY NECK", "code_information": [{"code": "75860", "type": "CPT"}], "standard_charges": [{"minimum": 99.47, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 118.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 118.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 128.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 118.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 118.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 121.42, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 131.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 121.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 159.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 95.52, "maximum": 584.01, "discounted_cash": 784.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 130.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 120.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 666.83, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 616.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 616.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 666.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 616.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 616.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY TRUNK", "code_information": [{"code": "75825", "type": "CPT"}], "standard_charges": [{"minimum": 80.81, "maximum": 584.01, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 110.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 110.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 119.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 110.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 110.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 99.38, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 173.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 99.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 101.21, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 149.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 149.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 161.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 149.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 101.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 158.71, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 269.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 249.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 158.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.75, "maximum": 7.3, "discounted_cash": 14.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 3947.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1811.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 153.2, "maximum": 584.01, "discounted_cash": 499.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 165.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 153.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENDAJE AC, PER SQ CM", "code_information": [{"code": "Q4279", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENDAJE, PER SQUARE CENTIMET", "code_information": [{"code": "Q4252", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 44.98, "maximum": 4936.0, "discounted_cash": 558.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 60.42, "maximum": 4936.0, "discounted_cash": 166.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 14433.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 4080.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2109.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 110.41, "maximum": 584.01, "discounted_cash": 6957.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 132.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 122.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 172.22, "maximum": 584.01, "discounted_cash": 678.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 209.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT NF PER DAY", "code_information": [{"code": "94004", "type": "CPT"}], "standard_charges": [{"minimum": 60.48, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 60.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9531.18, "maximum": 43513.92, "discounted_cash": 19054.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 28719.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 28719.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 43513.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38124.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 25118.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 21442.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 9531.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "31", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18702.65, "maximum": 100370.25, "discounted_cash": 40061.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 66245.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 66245.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 100370.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 87937.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 57939.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 49459.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 18702.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "33", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7120.72, "maximum": 32049.05, "discounted_cash": 14868.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 21152.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 21152.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32049.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 28079.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 18500.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15792.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7120.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY ANTERIOR APPROACH-CERVICAL-SINGLE SEGMENT 63081", "code_information": [{"code": "63081", "type": "CPT"}, {"code": "1482386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2132.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY PART/COMP. ANTERIOR CERVICAL EA ADD SEG 63082", "code_information": [{"code": "63082", "type": "CPT"}, {"code": "1839670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 304.29, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 304.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY TRANSTHORACIC APPROACH-THORACIC-SINGLE SEGMENT 63085", "code_information": [{"code": "63085", "type": "CPT"}, {"code": "1482385", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "gross_charge": 4737.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "standard_charge_dollar": 1894.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3829.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "standard_charge_dollar": 2842.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "standard_charge_dollar": 3079.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 2339.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEBROPLASTY ADDL INJECT", "code_information": [{"code": "22512", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 974.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESSEL LOOP RED0.9 MINI RADIOPAQUE LF", "code_information": [{"code": "HT9945710A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.2, "setting": "both", "billing_class": "facility"}]}, {"description": "VESSEL SEALER 10MM TO 20CM OPEN LIGASURE ATLAS LF STRL DISP", "code_information": [{"code": "LS1020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1427.29, "setting": "both", "billing_class": "facility"}]}, {"description": "VESTIBULAR DEV IMPLTJ UNI", "code_information": [{"code": "725T", "type": "CPT"}], "standard_charges": [{"minimum": 3292.0, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIALINDICATOR BROWN CAP BIOLOGICAL STRL RAPID READOUT ATTEST", "code_information": [{"code": "1292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.89, "setting": "both", "billing_class": "facility"}]}, {"description": "VIBRATE QUANT SENSORY TEST", "code_information": [{"code": "107T", "type": "CPT"}], "standard_charges": [{"minimum": 63.6, "maximum": 68.69, "discounted_cash": 46.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 68.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIM, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4251", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIPER VENOM PROTHROMBIN TIME", "code_information": [{"code": "85612", "type": "CPT"}], "standard_charges": [{"minimum": 15.74, "maximum": 584.01, "discounted_cash": 22.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 19.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4803.72, "maximum": 9748.37, "discounted_cash": 13396.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6434.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6434.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 9748.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8540.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5627.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4803.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 6586.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2414.75, "maximum": 4900.34, "discounted_cash": 7775.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 3234.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 3234.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4900.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4293.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 2828.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 2414.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 3948.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4943.45, "maximum": 10031.93, "discounted_cash": 17145.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 6621.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 6621.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 10031.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 8789.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 5791.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 4943.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7687.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3099.83, "maximum": 6290.61, "discounted_cash": 7378.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4151.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 4151.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 6290.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 5511.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 3631.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 3099.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 4092.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS ANTIBODY NOS", "code_information": [{"code": "86790", "type": "CPT"}], "standard_charges": [{"minimum": 11.59, "maximum": 584.01, "discounted_cash": 16.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 25.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 17.6, "maximum": 584.01, "discounted_cash": 25.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE TISSUE ADDL", "code_information": [{"code": "87253", "type": "CPT"}], "standard_charges": [{"minimum": 18.18, "maximum": 584.01, "discounted_cash": 26.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION SHELL VIA", "code_information": [{"code": "87254", "type": "CPT"}], "standard_charges": [{"minimum": 17.6, "maximum": 584.01, "discounted_cash": 25.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION TISSUE", "code_information": [{"code": "87252", "type": "CPT"}], "standard_charges": [{"minimum": 23.46, "maximum": 584.01, "discounted_cash": 33.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 48.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 48.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 51.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 48.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 48.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISCOAT 0.5 ML", "code_information": [{"code": "MED0217", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 550.96, "setting": "both", "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"minimum": 1251.77, "maximum": 1251.77, "discounted_cash": 1285.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1251.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1780.64, "maximum": 1780.64, "discounted_cash": 2019.88, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1780.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT TO DETERM LDCT ELIG", "code_information": [{"code": "G0296", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.4, "maximum": 39.4, "discounted_cash": 127.02, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 59.28, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 59.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 65.05, "maximum": 584.01, "discounted_cash": 269.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 206.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 206.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 223.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 206.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 65.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 272.64, "maximum": 294.45, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 294.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 272.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 230.16, "maximum": 4936.0, "discounted_cash": 674.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 230.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT D 1 25-DIHYDROXY", "code_information": [{"code": "82652", "type": "CPT"}], "standard_charges": [{"minimum": 34.65, "maximum": 584.01, "discounted_cash": 50.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 70.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 70.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 76.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 70.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 70.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1298.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1104.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1298.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6090.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1260.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1367.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6090.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5006.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY TEST", "code_information": [{"code": "94150", "type": "CPT"}], "standard_charges": [{"minimum": 38.34, "maximum": 584.01, "discounted_cash": 160.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 41.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CARE C-ARM DRAPES 42X74 VAE5603", "code_information": [{"code": "VAE5603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.39, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 26.64, "maximum": 48.02, "discounted_cash": 38.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 44.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 44.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 44.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 44.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VKORC1 GENE", "code_information": [{"code": "81355", "type": "CPT"}], "standard_charges": [{"minimum": 79.38, "maximum": 584.01, "discounted_cash": 114.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 131.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 79.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 79.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"minimum": 641.22, "maximum": 641.22, "discounted_cash": 926.21, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 641.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 641.22, "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": 142.31, "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": 301.99, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 6 LP VLOCA206L", "code_information": [{"code": "VLOCA206L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.22, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC ESTITCH NON ABS 0 8 LOOP VLOCN008L", "code_information": [{"code": "VLOCN008L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 397.35, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC SUTURE 180 ABS 2-0 GR 24 GS-21 VLOCL0335", "code_information": [{"code": "VLOCL0335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.4, "setting": "both", "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"minimum": 67.79, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 67.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"minimum": 63.98, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"minimum": 82.58, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 82.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL AT/ABV", "code_information": [{"code": "93587", "type": "CPT"}], "standard_charges": [{"minimum": 119.73, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 119.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"minimum": 120.7, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 27.8, "maximum": 584.01, "discounted_cash": 213.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 584.01, "discounted_cash": 15.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 4936.0, "discounted_cash": 551.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"minimum": 3167.0, "maximum": 4936.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"minimum": 16.56, "maximum": 16.56, "discounted_cash": 23.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"minimum": 15.54, "maximum": 15.54, "discounted_cash": 22.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incontinence", "code_information": [{"code": "58293", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1748.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vancomycin Level", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "633868", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.19, "maximum": 584.01, "gross_charge": 107.0, "discounted_cash": 17.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 1635.0, "maximum": 4936.0, "discounted_cash": 22920.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vasoreactivity study performed with transcranial 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{"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 7.74, "maximum": 584.01, "discounted_cash": 11.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 19.04, "maximum": 584.01, "discounted_cash": 46.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE BIOPSY OF LIVER", "code_information": [{"code": "47100", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1066.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"minimum": 185.14, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"minimum": 185.14, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 898.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 185.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1598.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1171.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 197.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 144.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 120.0, "maximum": 4936.0, "discounted_cash": 349.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 160.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 160.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 172.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 160.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 155.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS AB IGM", "code_information": [{"code": "86788", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 584.01, "discounted_cash": 21.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS ANTIBODY", "code_information": [{"code": "86789", "type": "CPT"}], "standard_charges": [{"minimum": 12.95, "maximum": 584.01, "discounted_cash": 18.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 28.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT TEST", "code_information": [{"code": "84181", "type": "CPT"}], "standard_charges": [{"minimum": 15.33, "maximum": 584.01, "discounted_cash": 22.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WET MOUNTS/ W PREPARATIONS", "code_information": [{"code": "Q0111", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.61, "maximum": 13.61, "discounted_cash": 24.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR MNGMENT TRAINING", "code_information": [{"code": "97542", "type": "CPT"}], "standard_charges": [{"minimum": 43.07, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 63.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL THERAPY", "code_information": [{"code": "97022", "type": "CPT"}], "standard_charges": [{"minimum": 21.14, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 43.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BLOOD FOR TRANSFUSION", "code_information": [{"code": "P9010", "type": "HCPCS"}], "standard_charges": [{"minimum": 391.3, "maximum": 422.6, "discounted_cash": 232.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 422.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BODY PHOTOGRAPHY", "code_information": [{"code": "96904", "type": "CPT"}], "standard_charges": [{"minimum": 86.51, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 120.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 129.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 86.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81460", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1879.02, "discounted_cash": 1673.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1737.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1737.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1879.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1737.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1737.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 1366.56, "discounted_cash": 1216.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1366.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1263.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIDE BLADE HOOK 6.5 179752046", "code_information": [{"code": "179752046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3192.97, "setting": "both", "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 89.04, "maximum": 4936.0, "discounted_cash": 203.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 120.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 120.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 130.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 120.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 89.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIPE GERMICIDAL AF3 SANI-WIPE", "code_information": [{"code": "P13872", "type": "CDM"}], "standard_charges": [{"gross_charge": 16.35, "setting": "both", "billing_class": "facility"}]}, {"description": "WIPE PHARMA STERILE 9X9IN 6X25CT 524231", "code_information": [{"code": "524231", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.04, "setting": "both", "billing_class": "facility"}]}, {"description": "WIPES SANI-HANDS INSTANT HAND SANITIZING NPKD43600", "code_information": [{"code": "NPKD43600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.19, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE 1.45IN Y", "code_information": [{"code": "145BA22-2", "type": "CDM"}], "standard_charges": [{"gross_charge": 14000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDE MED STANDARD METRIXINSTR", "code_information": [{"code": "955519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.62, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon  128-5663 12 8 180 2.8", "code_information": [{"code": "FW24105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon  128-5665 18 8 180 2.8", "code_information": [{"code": "FW24145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5660 6 8 180 2.8", "code_information": [{"code": "FW24075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5661 8 8 180 2.8", "code_information": [{"code": "FW24085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5662 10 8 180 2.8", "code_information": [{"code": "FW24095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5664 15 8 180 2.8", "code_information": [{"code": "FW24125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE-GUIDED SINGLE STAGE BALLOONS ABC Esophageal Dilatation Balloon 128-5666 20 8 180 2.8", "code_information": [{"code": "FW24155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.67, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRELESS HAND CONTROL WIRELESS-HC", "code_information": [{"code": "WIRELESS-HC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.83, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 164.06, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 232.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 232.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 250.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 232.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 164.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 246.0, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 265.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 98.26, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 98.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 98.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 106.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 98.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK RELATED DISABILITY EXAM", "code_information": [{"code": "99455", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND CLOSURE BY ADHESIVE", "code_information": [{"code": "G0168", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.85, "maximum": 1270.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 200.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 138.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13159.6, "maximum": 38676.9, "discounted_cash": 27849.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25527.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25527.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 38676.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 33886.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22326.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 19058.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 13159.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "463", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24104.66, "maximum": 58271.37, "discounted_cash": 50961.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 38459.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 38459.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 58271.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 51053.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 33637.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 28714.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 24104.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "465", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7748.21, "maximum": 30814.33, "discounted_cash": 16306.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 20337.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 20337.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 30814.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 26997.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17787.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 15184.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 7748.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8468.99, "maximum": 27450.16, "discounted_cash": 17118.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 18117.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 18117.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 27450.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24050.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 15845.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 13526.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 8468.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19354.61, "maximum": 39277.05, "discounted_cash": 37523.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 25923.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 25923.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 39277.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 34412.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 22673.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 19354.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 19773.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5440.84, "maximum": 15721.01, "discounted_cash": 10457.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 10375.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 10375.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 15721.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 13773.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 9075.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 7746.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMMUNITY - MEDICAID", "standard_charge_dollar": 5440.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP ADDL 100 CM", "code_information": [{"code": "15003", "type": "CPT"}], "standard_charges": [{"minimum": 98.26, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 150.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 98.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND PREP F/N/HF/G", "code_information": [{"code": "15004", "type": "CPT"}], "standard_charges": [{"minimum": 538.67, "maximum": 4936.0, "discounted_cash": 508.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 747.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 747.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 806.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 747.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 538.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 1270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "15002", "type": "CPT"}], "standard_charges": [{"minimum": 479.85, "maximum": 4936.0, "discounted_cash": 924.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1477.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 639.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 639.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 691.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 639.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 781.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 676.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 779.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 479.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3347.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND(S) CARE NON-SELECTIVE", "code_information": [{"code": "97602", "type": "CPT"}], "standard_charges": [{"minimum": 69.54, "maximum": 584.01, "discounted_cash": 250.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 69.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 69.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 75.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 69.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUNDEX, BIOSKIN, PER SQ CM", "code_information": [{"code": "Q4163", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUNDFIX BIOWOUND PLUS XPLUS", "code_information": [{"code": "Q4217", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.81, "maximum": 166.81, "discounted_cash": 155.6, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 166.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR 36X36 CH6G0036", "code_information": [{"code": "CH6G0036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.39, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 18X18 CH5G0018", "code_information": [{"code": "CH5G0018", "type": "CDM"}], "standard_charges": [{"gross_charge": 2.33, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 36X36 CH5G0036", "code_information": [{"code": "CH5G0036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.19, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERI 2 COLOR CH500 45X45 CH5G0045", "code_information": [{"code": "CH5G0045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.56, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION ONE-STEP LATEX FREE SMS FABRIC SIMULTANEOUS HEAVY 24 X 24IN", "code_information": [{"code": "62124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH500 24X24", "code_information": [{"code": "CH5G0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.39, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH600 45X45", "code_information": [{"code": "CH6G0045", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.19, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STERILIZATION TWO COLOR CH600 54X54 CH6G0054", "code_information": [{"code": "CH6G0054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.9, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STRL 36IN X 36IN CSR HEAVY WT ONE PLY GEMINI", "code_information": [{"code": "GEM4136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.58, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP STRL 45IN X 45IN BLUE CSR ONE PLY GEMINI LF", "code_information": [{"code": "GEM5145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.34, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH ANCHOR HEX 3 INCH M365SC42760", "code_information": [{"code": "M365SC42760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH BLADE TORQUE LOCK FOR HARMONIC SCALPEL CLEAR PLASTIC SLEEVE", "code_information": [{"code": "TLB01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH HEX 3IN", "code_information": [{"code": "SC-4276", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH TORQUE 4IN", "code_information": [{"code": "3550-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH TORQUE REACTIV8  5500A", "code_information": [{"code": "5500A", "type": "CDM"}], "standard_charges": [{"gross_charge": 303.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY", "code_information": [{"code": "29840", "type": "CPT"}], "standard_charges": [{"minimum": 581.31, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 581.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29843", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 618.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29844", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 622.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29845", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 723.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29846", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 4090.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 645.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29847", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 6923.0, "discounted_cash": 9072.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 682.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 6923.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 5691.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ENDOSCOPY/SURGERY", "code_information": [{"code": "29848", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2010.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1635.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1748.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 642.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 4722.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 3881.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST REPLACEMENT", "code_information": [{"code": "25446", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 8117.0, "discounted_cash": 21922.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3292.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 3613.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1393.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 8117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 6673.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRISTBAND SENTRY BAR CODE LABELBAND SHIELD  POLY 1-1/4\" X 11-3/4\" ADULT WHITE 500 PER BOX 5080-11-", "code_information": [{"code": "5080-11-PDM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 1.35, "maximum": 4936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1100.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding 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"OSCAR", "standard_charge_dollar": 380.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SWLNG FUNCJ C+", "code_information": [{"code": "74230", "type": "CPT"}], "standard_charges": [{"minimum": 80.6, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 80.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 80.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 87.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 80.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 80.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 125.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM UPR GI TRC 1CNTRST", "code_information": [{"code": "74240", "type": "CPT"}], "standard_charges": [{"minimum": 99.27, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 99.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 99.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 107.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 99.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 99.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM UPR GI TRC 2CNTRST", "code_information": [{"code": "74246", "type": "CPT"}], "standard_charges": [{"minimum": 117.5, "maximum": 584.01, "discounted_cash": 219.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 127.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 117.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS AT SURGERY ADD-ON", "code_information": [{"code": "74301", "type": "CPT"}], "standard_charges": [{"minimum": 24.65, "maximum": 584.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}], "standard_charges": [{"minimum": 94.21, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 105.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}], "standard_charges": [{"minimum": 88.41, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 88.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 88.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 95.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 88.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 88.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 94.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}], "standard_charges": [{"minimum": 57.61, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 64.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 57.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS FOR BONE AGE", "code_information": [{"code": "77072", "type": "CPT"}], "standard_charges": [{"minimum": 17.19, "maximum": 584.01, "discounted_cash": 130.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS TRANSCATH THERAPY", "code_information": [{"code": "75894", "type": "CPT"}], "standard_charges": [{"minimum": 247.71, "maximum": 1277.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 1180.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - LIMITED", "standard_charge_dollar": 1180.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 1277.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 1180.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS NETWORK EX", "standard_charge_dollar": 1180.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 247.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX W/ECP", "code_information": [{"code": "66987", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX WO ECP", "code_information": [{"code": "66982", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA PPO", "standard_charge_dollar": 1628.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 856.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC - COMMERCIAL", "standard_charge_dollar": 3442.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC COMPASS", "standard_charge_dollar": 2829.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 6653.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 790.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 5168.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 3167.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/O ECP", "code_information": [{"code": "66984", "type": "CPT"}], "standard_charges": [{"minimum": 584.01, "maximum": 4936.0, "discounted_cash": 2885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - BLUE NETWORK E", "standard_charge_dollar": 4015.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - PREFERRED", "standard_charge_dollar": 4936.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS - SELECT", "standard_charge_dollar": 4232.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS MISSION POINT", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 1854.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUECARE TENNCARE SELECT", "standard_charge_dollar": 584.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUEGRASS FAMILY HEALTH - SINGLE SOURCE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": 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